Scientific American: Health Fat Substitutes May Make You FatterResearch with rats reveals that fat substitutes may prime the body to consider all fats to be low-calorie and thus decrease the ability to burn real fats efficiently--leading to weight gain. Karen Hopkin reports

| June 24, 2011 | 3 Counting on food with fake fats to help you slip into last year’s bathing suit? Better count again. Because a new study with rats shows that low-cal fat substitutes can actually promote weight gain. The work appears in the journal Behavioral Neuroscience. [Susan Swithers, Sean Ogden and Terry Davidson, "Fat Substitutes Promote Weight Gain in Rats Consuming High-Fat Diets"]

Dieters can choose from an array of snacktackular options in which sugars and fats are replaced by artificial, low-calorie substitutes. That sleight of hand seems ingenious. You can let your body think it’s getting the sweets and fats it craves while keeping the calorie count to a minimum.

But the new study suggests that this strategy is likely to backfire. Rats that consumed a mix of full-fat chips and chips with olestra wound up eating more and got fatter than rats that noshed on regular chips alone.

Their bodies were apparently getting mixed messages. A mouthful of fat is usually a signal that calories are coming, and the body reacts by getting ready to burn fuel. But olestra, which tastes like fat, carries no calories at all. So the body soon learns to stand down in the face of fat. All fat. Even real fat. Because as Shakespeare almost said, a chip by any other name still swells your seat.

Should we call this itchology? From Scientific American to the University of Washington itch study center.

Itch was once considered a milder form of pain on a spectrum. Not these days. When one feels pain one reflexively withdraws away from the stimilus that leads to pain sensation.When one feels itch one reflexively moves the limb toward the itch sensation:

****Center for the Study of Itch opens March 17, 2011 By Jim Dryden Forward Facebook this Tweet this Share more Audio download available In the spinal cord, neurons expressing GRPR, which appears blue in this image, carry itch signals to the brain.

Chen lab, Washington University School of MedicineWashington University School of Medicine in St. Louis has launched its new Center for the Study of Itch, believed to be the world’s first multidisciplinary program designed solely to understand and treat itch.

The center was established to bring scientists and clinicians together to conduct research on the mechanisms that transmit itch and, ultimately, to translate those findings into better treatments for chronic sufferers.

Patients with chronic itch include those with certain types of cancer and those with liver and kidney disease. Some also may develop itching as a result of certain medical treatments or in response to pain-killing drugs. Skin diseases, such as psoriasis and atopic dermatitis, as well as allergic reactions, also cause itching. Antihistamines often are prescribed to treat itching caused by these latter conditions. The great majority of conditions that cause chronic itch, however, are resistant to antihistamine treatment, and some can be very debilitating.

“This center represents an important step in science’s understanding of a poorly understood phenomenon that can negatively affect quality of life for many people,” says Larry J. Shapiro, MD, executive vice chancellor for medical affairs and dean of the School of Medicine. “The new center should help speed the pace of discoveries into the basic, biological causes of itch and quickly translate them into more effective therapies.”

Historically, itch was regarded as a less intense version of pain. As a result, basic research on itching has been neglected. Only in the last few years has itch been studied as its own entity at a molecular level using mouse genetics, an approach that has long been employed to advance our understanding of numerous diseases in many other fields.

In fact, Zhou-Feng Chen, PhD, director of the new center and professor of anesthesiology, of psychiatry and of developmental biology, became interested in itch while looking for genes in the spinal cord’s pain pathway. Among the potential pain-sensing genes his team found was gastrin-releasing peptide receptor (GRPR), which turned out to be the first itch-specific receptor to be identified. Chen’s team showed that when mice were exposed to things that make them itchy, those without a GRPR gene scratched less than their normal littermates.

That led to other findings about itch and how itch signals travel along the spinal cord to the brain. Chen’s studies strongly suggest that itch and pain signals are transmitted along different pathways, so he says the time has arrived to study itch as a disease in its own right.

“There are many pain centers around the world, but we believe this will be the first center to focus on itch exclusively,” Chen says. “In fact, chronic itch is a disease of the nervous system manifested in the skin, but we understand very little about basic mechanisms and effective treatments.”

Center for the Study of ItchTo determine whether the itch signal in different conditions is transmitted through the same pathway, the center plans to establish animal models that mimic certain aspects of human chronic itch.

The center has two primary sections: the basic research and behavioral core based in the Department of Anesthesiology; and the section on clinical research, trials and patient care. Chen, who directs the basic research section, and his colleagues work with animal models and focus on genes and molecules related to itch. Lynn A. Cornelius, MD, co-director of the center and chief of the Division of Dermatology in the Department of Medicine, will direct the clinical side. As the research progresses and better insights into the mechanisms driving itch are gained, her team ultimately will evaluate and treat patients with chronic itch.

Researchers plan to collect skin biopsies from current patients who itch to create a clinical research database and biobank, providing a unique resource for identifying genetic susceptibilities for chronic itch in humans. Cornelius and her colleagues also will conduct clinical trials of potential therapeutic agents and treatment approaches.

“Itch is not just a reflex but a unique sensation,” Cornelius says. “Similar to pain, it is likely transmitted through unique neural pathways from the skin to the brain. We envision that functional imaging will be an important part of the clinical research effort. With our colleagues in neurology, we hope to both identify specific areas of the brain that are active when a person perceives the sensation of itch. Similarly, we would use imaging to track changes in these specific areas as effective treatments are administered.”

In addition to basic and translational research, the center will provide educational training opportunities for scientists interested in studying itch. The center is hiring three full-time faculty members to initiate more studies that focus on itch, its causes and potential treatments.

Chen and Cornelius also will collaborate with faculty members from other centers, departments and divisions.

“One of our major goals is to spur translational research that can bring discoveries from the bench to the clinic,” Chen says. “That requires many different kinds of expertise, so we are very excited to be joining forces with scientists whose expertise complements our own.”****

The only reason to decriminalize this drug is to take the profit motive out of it. That may be a good reason to make it legal but no other reason I can see is legitimate. Not to tax it and not for "medicinal" purposes in vast majority of most cases. Medically it is a sham except for maybe those who are otherwise in unusual situations like on chemotherapy or terminally ill. People who want it legal are mostly hippies, druggies, or those who want to profit from it. With all the problems facing this country we need to debate over pot?

Medical marijuana in Denver (Ed Andrieski/AP)The Obama administration's newly released drug control strategy slams states that have legalized medical marijuana, arguing that smoking any drug is unsafe--and that marijuana's medical benefits have yet to be evaluated by the FDA.

"While there may be medical value for some of the individual components of the cannabis plant, the fact remains that smoking marijuana is an inefficient and harmful method for delivering the constituent elements that have or may have medicinal value," the White House's National Drug Control Strategy for 2011 says.

The strongly anti-marijuana report comes on the heels of the Justice Department's decision against reclassifying marijuana as a less dangerous drug. As The Los Angeles Times reports, the government took nine years to respond to marijuana advocates' request that they take into account studies that show marijuana has medical benefits and reclassify the drug. At the end of its review, the Justice Department held firm to its earlier decision that marijuana should be classified alongside other dangerous drugs such as heroin. The Americans for Safe Access group is now appealing the decision in federal court, the paper says.

It's unclear what the consequences will be for people involved in the medical marijuana business in the 16 states (and Washington, D.C.) that currently allow it. The report states unequivocally that "outside the context of Federally approved research, the use and distribution of marijuana is prohibited in the United States," and the Justice Department recently suggested in a memo that state-approved marijuana dispensaries and growers could face prosecution.

The report also made a detailed case against legalization or decriminalization of marijuana, an idea that has won the endorsement of a group of ex-global leaders who called the war on drugs a "failure." The report says that while tobacco and alcohol are legalized and taxed, neither provide a "net economic benefit to society," due to health-care expenses and various criminal justice costs, such as drunken driving arrests.

Neil Franklin, the director of a pro-legalization group of former police and other law-enforcement agents called Law Enforcement Against Prohibition, said in a statement that the anti-marijuana tone of the administration is disappointing.

"It's sad that the drug czar decided to insert a multi-page rant against legalizing and regulating drugs into the National Drug Control Strategy instead of actually doing his job and shifting limited resources to combat the public health problem of drug abuse," Franklin said.****

I don't know too many people that would keep marijuana from a chemo patient, but medical marijuana seems to be most often used by people who have some mysterious disease that allows them to snowboard 5 days a week.

"...most often used by people who have some mysterious disease that allows them to snowboard 5 days a week."

The Colorado system is full of abuse including no oversight of the 'doctors' and leaving the dispensaries unregulated. It seems like the recommending doctors could be vulnerable for the mockery of medicine and law.

For CCP: "The use of medical marijuana in Colorado patients suffering from severe chronic pain has shown in multiple studies to lift moods of depression and reduce or even sometimes completely alleviate pain symptoms without drugs." http://coloradomedicalmarijuana.com/qualifying-conditions.htm - THC is not a drug?

I prefer decriminalization with minor penalties for small quantities to this scam that drags in the medical profession. Real medical uses should of course be permitted, and exemptions from rules for the terminal should extend to whatever their doctor thinks would be helpful.

But it's hard to know who is terminal these days after the amazing recovery of the Lockerbie bomber.

I am sure there are some doctors along with everyone else who are abusing the drug prescirption thing.

"The Colorado system is full of abuse including no oversight of the 'doctors' and leaving the dispensaries unregulated."

We don't need doctors prescribing this garbage (pot). We can't even control the narcotics prescriptions. I do my best yet I have a single digit number of patients who I suspect are taking advantage of the drugs yet I can't prove it. One actually did tell me she went snowboarding! She shut up fast when I just glared at her. I thought she was in such pain.

The doctors who blatantly participate in the drug dispensing scams are I truly think a small minority. Although I don't have a good handle as to how many do this. I really think most of us *cannot stand* the scammers who come in trying to con us for drugs. Most of druggies can be filtered out but a few are really tough to tell from people truly in need in my estimations. Some are superb bullshit artists - like the people in the music/entertainment industry.

Katherine is insulin dependent diabetic. She does not have a pump. We have thought that a pump would be very dangerous since every single thing she does is monitored by the organized criminals stealing her lyrics. There is no electronic device that cannot be hacked if wireless capable or physically accessed if wireline or not wireless. We have certainly thought of this. Most people have no clue the threat to us of this threat with regards to criminal activity. It is rampant. It is going on. Katherine even wondered if the dentist could not have implanted a "bug" in her teeth at one point. The criminals thought this hilarious and even used it in a Progressive auto insurance commerical when that obnoxious broad claims she had to get the "bugs out of her teeth" from riding a motorcycle. That was a direct mock to us. Sound crazy. It is not. I kid you not.

To my knowledge there is no law enforcement taking any of this even remotely seriously. Yet I know they are all worried about their pensions and early retirement schemes. Sorry for the dig but yes I am angry.

Jay Radcliffe, who wrote a program to attack an insulin pump, taking control of the …LAS VEGAS (AP) — Even the human bloodstream isn't safe from computer hackers.

A security researcher who is diabetic has identified flaws that could allow an attacker to remotely control insulin pumps and alter the readouts of blood-sugar monitors. As a result, diabetics could get too much or too little insulin, a hormone they need for proper metabolism.

Jay Radcliffe, a diabetic who experimented on his own equipment, shared his findings with The Associated Press before releasing them Thursday at the Black Hat computer security conference in Las Vegas.

"My initial reaction was that this was really cool from a technical perspective," Radcliffe said. "The second reaction was one of maybe sheer terror, to know that there's no security around the devices which are a very active part of keeping me alive."

Increasingly, medical devices such as pacemakers, operating room monitors and surgical instruments including deep-brain stimulators are being made with the ability to transmit vital health information from a patient's body to doctors and other professionals. Some devices can be remotely controlled by medical professionals.

Although there's no evidence that anyone has used Radcliffe's techniques, his findings raise fears about the safety of medical devices as they're brought into the Internet age. Serious attacks have already been demonstrated against pacemakers and defibrillators.

Medical device makers downplay the threat from such attacks. They argue that the demonstrated attacks have been performed by skilled security researchers and are unlikely to occur in the real world.

But hacking is like athletics. Showing that a far-fetched attack is possible is like cracking the 4-minute mile. Once someone does it, others often follow. Free or inexpensive programs eventually pop up online to help malicious hackers automate obscure attacks.

Though there has been a push to automate medical devices and include wireless chips, the devices are typically too small to house processors powerful enough to perform advanced encryption to scramble their communications. As a result, most devices are vulnerable.

Radcliffe wears an insulin pump that can be used with a special remote control to administer insulin. He found that the pump can be reprogrammed to respond to a stranger's remote. All he needed was a USB device that can be easily obtained from eBay or medical supply companies. Radcliffe also applied his skill for eavesdropping on computer traffic. By looking at the data being transmitted from the computer with the USB device to the insulin pump, he could instruct the USB device to tell the pump what to do.

Radcliffe, who is 33 and lives in Meridian, Idaho, tested only one brand of insulin pump — his own — but said others could be vulnerable as well.

Although an attacker would need to be within a couple hundred feet of the patient to pull this off, a stranger wandering a hospital or sitting behind a target on an airplane would be close enough.

Radcliffe also found that it was possible to tamper with a second device he wears. He found that he could intercept signals sent wirelessly from a sensor to a machine that displays blood-sugar levels. By broadcasting a signal that is stronger than the real-time, authentic readings, the monitor would be tricked into displaying old information over and over. As a result, a patient who didn't notice wouldn't adjust insulin dosage properly.

With a powerful enough antenna, Radcliffe said, an attacker could be up to half a mile away. This attack worked on two different blood-sugar monitors, Radcliffe said.

"Everybody's pushing the technology to do more and more and more, and like any technology that's pushed like that, security is an afterthought," Radcliffe said.

Radcliffe refused to identify any of the three device makers, in part out of concern for his own safety. He is concerned that the devices don't appear to have an easy way to be updated with new software to fix the problems. He said he intends to notify the manufacturers after Thursday's presentation outlining the weaknesses.

The hacking fears come on top of human errors and technical glitches tied to medical devices. The U.S. Food and Drug Administration has identified software and design errors as critical concerns in investigating hundreds of deaths potentially linked to drug pumps.

FDA officials declined to comment specifically on Radcliffe's findings, saying they hadn't seen the research. But the FDA said that any medical device with wireless communication components can fall victim to eavesdropping. It warns device makers that they are responsible for making sure they can update equipment after it's sold.

Industry officials downplay the potential threat.

"The risk to a patient with diabetes of having their monitors hacked is extraordinarily small, and there's a greater health risk of not monitoring than the risk of being hacked," said Wanda Moebius, a vice president at the Advanced Medical Technology Association, an industry group.

Few public studies have been done on the susceptibility of medical devices to hacking.

One such study, which appeared in 2008 from a consortium of academics, found that a popular type of device that acted as both a pacemaker and defibrillator could be remotely reprogrammed to deliver potentially deadly shocks or run out its battery.

The problem was the way the device transmitted data unencrypted and accepted commands wirelessly from unauthorized devices. One limitation of the study was that researchers only examined an attack from a few centimeters away from the targeted device.

Yoshi Kohno, a University of Washington professor of computer science who was a co-author of that study, said that Radcliffe's new research reinforces the urgency of addressing security issues in medical devices before attacks move out of research labs.

"The threat hasn't manifested yet, so what they and we are trying to do is see what the risk could be in the future," said Kohno, who wasn't part of Radcliffe's research.

Radcliffe said the point of his research is not to alarm people. He said the issues he's discovered are important to address publicly as the medical industry moves aggressively toward more networked devices.

"It would only take one person to do this to kill someone and then you have a catastrophe," he said.****

I guess my only question is the extra three years of life span spent on the treadmill :

****15 Minutes' Daily Exercise May Boost Life Expectancy By Three Years.ABC World News (8/15, story 9, 0:30, Sawyer) reported, "If you need any more convincing that a little bit of exercise can make a huge difference in your life, here's some powerful new proof: A study in the medical journal Lancet looked at 400,000 people and found just 15 minutes of exercise a day increases life expectancy three years."

The AP (8/16, Chang) reports that "researchers at the National Health Research Institutes in Taiwan" noting that World Health Organization guidance , CDC recommendations , and guidelines from "other countries recommend that adults get at least a half-hour of moderate workout most days of the week," conducted the study to determine whether "exercising less than the recommended half-hour was still helpful." They asked "about 416,000 Taiwanese adults" how much exercising they "did the previous month" and recorded study participants' "progress for eight years on average." The research team found those who "exercised just 15 minutes a day -- or 90 minutes a week -- cut their risk of death by 14 percent" compared with those who did not exercise; and both men and women "benefited equally" from exercising.****

The Richmond Times-Dispatch reported that Christian Alexander Strickland, 9, of Henrico County, became infected after he went to a fishing camp in the state.

The child died from meningitis Aug. 5 and Bonnie Strickland, his aunt, told the paper that Naegleria fowleri — or "brain-eating ameba" as it is sometimes known — was a suspected cause of the illness.

"The doctor described it to us as such a slight chance that they didn't even think it would be possible," Bonnie Strickland told the Times-Dispatch.

Health department officials told the paper they do not comment on individual cases. However, they confirmed a case of meningitis and an infection by the bug.

"Sadly, we have had a Naegleria infection in Virginia this summer," Dr. Keri Hall, state epidemiologist at the Virginia Department of Health, in a statement, according to the Times-Dispatch. "It's important that people be aware of … safe swimming messages."

Naegleria fowleri moves into the body through the nose and destroys brain tissue. It almost always causes meningitis, the paper said.

It is usually found warm, stagnant water in freshwater lakes, ponds and rivers. It can also be found in wells.

'I didn't get my miracle' Earlier this month, Courtney Nash, 16, died as a result of a Naegleria fowleri infection in Florida after swimming in the St. John's River, ABC News reported.

NBC-affiliate WESH.com reported that she was diving off a dock with family at her grandmother's house when it is thought that she caught the disease.

Courtney's mother, Patricia Nash, said that shortly before her death, Courtney had decided to become an organ donor.

She told WESH that both lungs were transplanted and Courtney's liver and pancreas were "performing another miracle for someone else." Her kidneys were also being transplanted.

"I didn't get my miracle, but she has performed other miracles," Patricia Nash said, according to WESH. "If we can save other people's lives so they don't have to go through what I just went though, this could be a blessing in disguise."

According to the Centers for Disease Control and Prevention, the ameba "enters the nasal passages ... and migrates to the olfactory nerves, eventually invading the brain."

"From 1995 to 2004, N. fowleri killed 23 persons in the United States, including 2 children in the Phoenix, Arizona, area in 2002, who had been exposed to well water but had not consumed it. There have been 6 documented deaths in 2007, all in warmer regions (Arizona, Texas, Florida)," according to the CDC.

Vampire bats could save stroke victims Stroke victims are being treated with saliva from vampire bats as part of a trial at ten NHS hospitals.

A drug derived the saliva of vampire bats can thin blood and dissolve blood clots in the brain, saving lives and limiting the damage caused by strokes. By Laura Donnelly, Health CorrespondentResearch has found that a drug derived from the substance can thin blood and dissolve blood clots in the brain, saving lives and limiting the damage caused by strokes.

Currently, patients who suffer most types of strokes need to have clot-busting injections within four hours of the attack for the treatment to work.

But studies have found that jabs using a medicine derived from protein in bats' saliva can have the same effect for up to nine hours.

The difference means the drug called Desmoteplase could be given to patients who suffer a stroke while asleep and then wake up hours later.

Vampire bats have been chosen because they use their spit to keep the blood of their prey thin enough to drink.

Related ArticlesVampire bats use infra-red sensors to guide them to blood 03 Aug 2011 Vampire clot-buster 10 Jan 2003 Killer vampire bats attack 500 13 Aug 2010 Doctors at the University Hospital of North Staffordshire are among the first in the UK to test whether vampire bat saliva can save more lives among stroke victims than other treatments.

Consultant Dr Christine Roffe said the NHS trial was in its early stages, but that if it went well, it could be in widespread use within three years.

NHS stroke units in Newcastle, London, Bournemouth, Glasgow, Liverpool and Exeter are also among more than 40 hospitals taking part in the international research, involving about 400 patients.

Researchers who carried out a previous smaller study said the drug showed such promise that it was "the biggest breakthrough" in stroke treatment for two decades.

More than 80 per cent of strokes occur when the blood supply stops because of a clot in the brain. This type of stroke – called an ischaemic attack – can respond to clot-busting injections.

A second type of attack, called a haemorrhagic stroke, occurs when a weakened blood vessel supplying the brain bursts and causes brain damage.

Emergency surgery is often needed to treat such strokes in order to remove blood from the brain and repair burst blood vessels.

But home economics is more than a 1950s teacher in cat’s-eye glasses showing her female students how to make a white sauce. Reviving the program, and its original premises — that producing good, nutritious food is profoundly important, that it takes study and practice, and that it can and should be taught through the public school system — could help us in the fight against obesity and chronic disease today.

The home economics movement was founded on the belief that housework and food preparation were important subjects that should be studied scientifically. The first classes occurred in the agricultural and technical colleges that were built from the proceeds of federal land grants in the 1860s. By the early 20th century, and increasingly after the passage of federal legislation like the 1917 Smith-Hughes Act, which provided support for the training of teachers in home economics, there were classes in elementary, middle and high schools across the country. When universities excluded women from most departments, home economics was a back door into higher education. Once there, women worked hard to make the case that “domestic science” was in fact a scientific discipline, linked to chemistry, biology and bacteriology.

Indeed, in the early 20th century, home economics was a serious subject. When few understood germ theory and almost no one had heard of vitamins, home economics classes offered vital information about washing hands regularly, eating fruits and vegetables and not feeding coffee to babies, among other lessons.

Eventually, however, the discipline’s basic tenets about health and hygiene became so thoroughly popularized that they came to seem like common sense. As a result, their early proponents came to look like old maids stating the obvious instead of the innovators and scientists that many of them really were. Increasingly, home economists’ eagerness to dispense advice on everything from eating to sleeping to posture galled.

Today we remember only the stereotypes about home economics, while forgetting the movement’s crucial lessons on healthy eating and cooking.

Too many Americans simply don’t know how to cook. Our diets, consisting of highly processed foods made cheaply outside the home thanks to subsidized corn and soy, have contributed to an enormous health crisis. More than half of all adults and more than a third of all children are overweight or obese. Chronic diseases associated with weight gain, like heart disease and diabetes, are hobbling more and more Americans.

In the last decade, many cities and states have tried — and generally failed — to tax junk food or to ban the use of food stamps to buy soda. Clearly, many people are leery of any governmental steps to promote healthy eating; Michelle Obama’s campaign against childhood obesity has inspired right-wing panic about a secret food police.

But what if the government put the tools of obesity prevention in the hands of children themselves, by teaching them how to cook?

My first brush with home economics, as a seventh grader in a North Carolina public school two decades ago, was grim. The most sophisticated cooking we did was opening a can of pre-made biscuit dough, sticking our thumbs in the center of each raw biscuit to make a hole, and then handing them over to the teacher, who dipped them in hot grease to make doughnuts.

Cooking classes for public school students need not be so utterly stripped of content, or so cynical about students’ abilities to cook and enjoy high-quality food.

A year later, my father’s job took our family to Wales, where I attended, for a few months, a large school in a mid-size industrial city. There, students brought ingredients from home and learned to follow recipes, some simple and some not-so-simple, eventually making vegetable soups and meat and potato pies from scratch. It was the first time I had ever really cooked anything. I remember that it was fun, and with an instructor standing by, it wasn’t hard. Those were deeply empowering lessons, ones that stuck with me when I first started cooking for myself in earnest after college.

In the midst of contracting school budgets and test-oriented curricula, the idea of reviving home economics as part of a broad offensive against obesity might sound outlandish. But teaching cooking — real cooking — in public schools could help address a host of problems facing Americans today. The history of home economics shows it’s possible.

Helen Zoe Veit, an assistant professor of history at Michigan State University, is the author of the forthcoming “Victory Over Ourselves: American Food in the Era of the Great War.”

This seems to me a very good thing.======================================

By BILL TOMSON U.S. inspectors on Monday started using more sensitive tests to detect antibiotics in pork, part of a stepped-up effort to ensure meat safety after a government report last year suggested consumers might be at risk from harmful drug residues.

While a small, but growing amount of meat products are touted as being free of antibiotics, most meat isn't.

Livestock owners feed millions of pounds of antibiotics such as penicillin each year to cattle, hogs, chickens and turkeys to prevent disease and promote rapid growth. Conventional beef and pork are supposed to meet strict limits on levels of these drugs, and U.S. Department of Agriculture inspectors test tens of thousands of animals a year for compliance.

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Ground beef often comes from older dairy cows that receive antibiotics..USDA officials say the new tests will expand the number of antibiotics they can detect in pork, and that the agency can withhold meat with too much antibiotic residue from the market. More contaminated meat "will consequently be removed from the food supply," said USDA spokesman Dirk Fillpot. The new measures come as the agency is broadening its scrutiny of disease-causing E. coli bacteria in beef to a total of seven strains, instead of just one.

The new tests follow a report in March of 2010 by the USDA's inspector general citing "serious shortcomings" in the agency's inspection program. The report said the USDA allowed meat from certain slaughterhouses into the market even when it consistently found samples with excessive drug levels.

Inspection results from 2009, the latest available, showed the vast majority of cattle and pigs fell within the accepted limit for antibiotic residues.

"Using a more sensitive test should not be interpreted as a sign of a growing problem," said Janet Riley, a spokeswoman for the American Meat Institute, an industry group. "It means that new technology is being put to use to garner more information."

The new tests of pork follow the agency's updating of its beef testing last year.

The USDA inspector general's report said, "the effects of these residues on human beings who consume such meat are a growing concern." It said residue of penicillin in meat could trigger reactions in people with an allergy to the drug, though it didn't cite any cases.

The effect on people of consuming over a lifetime tiny quantities of penicillin, neomycin and other drugs left over in meat is little studied. Scott Hurd, an associate professor at Iowa State University's College of Veterinary Medicine, said there is no evidence of ill effects from such consumption.

The Food and Drug Administration also has been concerned about the rise of drug-resistant pathogens, and last year asked livestock producers to limit the amount of antibiotics they use.

Ingesting the drugs over an extended period could, in theory, promote the evolution of antibiotic-resistant bacteria in the body, making medical treatments more difficult if they spread in the population, said Kim Lewis, a microbiology professor and director of the Antimicrobial Discovery Center at Northeastern University.

Concern about how the heavy use of antibiotics might spur the growth of drug-resistant bugs has grown following the discovery in ground turkey of salmonella Heidelberg bacteria, which is resistant to several common antibiotics.

Two weeks after recalling 36 million pounds of contaminated ground turkey that sickened more than 100 people, Cargill Inc. announced a second recall on Sunday.

Mr. Fillpot said the USDA hasn't decided yet whether to introduce new, more stringent antibiotic-residue testing of turkey or chicken.

To check for antibiotic residues, USDA inspectors swab the kidneys of animals. Each year, the USDA takes a random sampling and a more targeted one in which inspectors test carcasses deemed more likely to be a source of contamination, such as those with lesions or other signs of illness.

Results from a 2009 targeted inspection showed the highest levels of antibiotic residues in older dairy cows sent for slaughter—the main source of hamburger in the U.S.—and young calves known as bob veal born from those cows.

About 1% each of the 80,000 dairy cows and 37,000 bob veal calves tested carried residues above FDA tolerance levels. In a quarter of the cases, penicillin was the culprit. The updated tests are better at finding 14 kinds of antibiotics that prior tests screened for, and can detect three other antibiotics that the older ones couldn't, the agency said.

Earlier tests suggested that pork was nearly 100% free of problematic antibiotic levels. The USDA's food-inspection service expects to find more contaminated meat with the new tests, Mr. Fillpot said.

A poor showing on tests typically doesn't trigger a recall because the government can't show eating a single serving of meat with antibiotic residue causes immediate sickness or death, according to the inspector general's report.

By LAURA LANDRO With more medical information than ever before at their fingertips, patients increasingly feel empowered to make their own decisions about care—or overpowered by all that data.

In "Your Medical Mind," oncologist Jerome Groopman, and his wife, endocrinologist Pamela Hartzband, offer a road map for navigating the medical maze and the mountains of information that Google searches produce. In an era when the magisterial physician who dictates care is obsolete, the book may be a welcome guide for those who are daunted by the choices they face, ranging from taking a cholesterol-lowering drug to making end-of-life decisions for a loved one.

Dr. Groopman is the author of four other books that have helped demystify medicine for a lay audience, including "How Doctors Think." "Your Medical Mind" analyzes how patients think as they weigh the pros and cons of different options, especially when they are presented with conflicting evidence and advice. "The unsettling reality," the authors note, "is that much of medicine still exists in a gray zone, where there is no black or white answer about when to treat or how to treat."

The books draws heavily on the approach known as shared medical decision-making, which has been promoted by researchers at Dartmouth College and others. This approach holds that doctor and patient together should review information about the risks and benefits of any given treatment and then customize care according to the patient's values and preferences.

To illustrate, the authors use anecdotes from real patients like Dave Simon, an avid tennis player diagnosed with atrial fibrillation, an abnormal heart rhythm. He must choose whether to take a blood-thinning medication that may prevent stroke from a clot but that can also cause internal bleeding. He is afraid to take the medication but is more terrified of having a stroke. Complicating matters: There is a new blood thinner on the market with a smaller risk of bleeding—but slightly more risk of heart attack. Mr. Simon, with his doctor, reviews the data on the risks, but he also thinks hard about his own mind-set: He's a doubter when it comes to new treatments. He goes with the more established medication.

The authors categorize patients like Mr. Simon by their biases: Are they believers in the benefits of medical intervention or has experience or upbringing made them skeptics? Are they apt to go for the maximum amount of care or the minimal amount that's still likely to get the job done? Do they embrace technology or are they inclined to natural solutions?

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Close.Your Medical MindBy Jerome Groopman and Pamela Hartzband (The Penguin Press, 308 pages, $27.95).Drs. Groopman and Hartzband have had their own experiences as patients, including Dr. Groopman's disastrous and well-chronicled experience with back surgery, which changed him from a maximalist to a more risk-averse patient. Dr. Hartzband says that she is a minimalist, avoiding medicines and supplements unless absolutely necessary. Both say that they are mindful in their practices not to impose their preferences on patients.

A dilemma often arises, though: where to draw the line between a patient's preference and the strongest medical evidence. The authors acknowledge that patient autonomy is taken too far when a doctor neglects his role as guide and puts the burden of choice entirely on the patient's shoulders. The closest that "Your Medical Mind" comes to a solution is noting that when patients want to know what their doctors think, the answer should be offered only "after information is presented in a neutral way."

One approach the authors examine is a formula for rational decision-making often used in economics: Measure the probability of an outcome and place a numerical value on the outcome itself. In medicine, that would mean finding out the probability of a particular outcome from a proposed medical treatment and then placing a numerical value on the state of health that such an outcome would bring about. Simple multiplication (the probability-percentage times the numerical value) will yield a number that can be compared with the numbers derived from other treatments. The highest number indicates the most rational or "best" choice.

The best choice, of course, may differ from patient to patient. For example, the treatments for Graves' disease, which results from an overactive thyroid gland, include radioactive iodine, surgery and medication, but there are differences in potential negative outcomes and side effects. The authors tell us about Lily Chan, a 27-year-old social worker who has the disease. She fears radioactive iodine and worries that it may increase the risk of cancer, so she chooses surgery. Anna Gonzales, a 42-year-old journalist with three kids, has no fear of radioactive iodine and isn't bothered that the treatment will also require her to take a thyroid-hormone pill every day for the rest of her life—a prospect that 36-year-old Patrick Baptiste, another Graves' patient, can't bear to contemplate.

Naturally, it can be hard to imagine a disease's progress or the effects of possible treatments, and weighing all the options can be exhausting. "Having many options," the authors observe, "can be more distressing than having fewer options and can impede our ability to make a sound decision, or any decision." Even when a choice doesn't turn out as we had hoped, though, "we often underestimate the reservoir of our resilience."

Prostate cancer patients, for example, face choices that include watchful waiting, radiation and surgery. Concerning the two medical interventions, the specialists advising their patients may well focus on the bad side effects of the other's approach (incontinence, impotence). One prostate-cancer patient that Drs. Groopman and Hartzband discuss, Matt Conlin, speaks to 20 doctors about his disease, and he quizzes other patients about their experiences—even if he is embarrassed by asking about their sex lives or bladder issues. He decides to go ahead with robotic surgery, a newer approach, and does suffer some bad side effects. But he is rid of his cancer, and he resolves that it is time to move forward without regret—a choice that may be the best outcome for any medical decision.

They may not listen. After all, the vast majority of men over 50 already get tested.

The idea that finding cancer early can harm instead of help is a hard one to understand. But it's at the heart of a government panel's draft recommendation that those PSA blood tests should no longer be part of routine screening for healthy men.

The U.S. Preventive Services Task Force examined all the evidence and found little if any reduction in deaths from routine PSA screening. But it did conclude that too many men are diagnosed with tumors that never would have killed them and suffer serious side effects from resulting treatment.

That recommendation isn't final — it's a draft open for public comment. But it goes a step further than several major cancer groups including the American Cancer Society, which urges that men be told the pros and cons and decide for themselves.

The new advice is sure to be hugely controversial. Already some doctors are rejecting it.

"We all agree that we've got to do a better job of figuring out who would benefit from PSA screening. But a blanket statement of just doing away with it altogether ... seems over-aggressive and irresponsible," said Dr. Scott Eggener, a prostate cancer specialist at the University of Chicago.

In the exam room, explaining the flaws in PSA testing has long been difficult.

"Men have been confused about this for a very long time, not just men patients but men doctors," said Dr. Yul Ejnes, a Cranston, R.I., internal medicine specialist who chairs the American College of Physicians' board of regents.

He turned down his own physician's offer of a PSA test after personally reviewing the research.

"There's this dogma ... that early detection saves lives. It's not necessarily true for all cancers," Ejnes said.

That's an emotional shift, as the American Cancer Society's Dr. Len Lichtenfeld voiced on his blog on Friday.

"We have invested over 20 years of belief that PSA testing works. ... And here we are all of these years later, and we don't know for sure," Lichtenfeld wrote. "We have been poked and probed, we have been operated on by doctors and robots, we have been radiated with fancy machines, we have spent literally billions of dollars. And what do we have? A mess of false hope?"

Too much PSA, or prostate-specific antigen, in the blood only sometimes signals prostate cancer is brewing. It also can mean a benign enlarged prostate or an infection. In fact, most men who undergo a biopsy for an abnormal PSA test don't turn out to have prostate cancer.

Screening often detects small tumors that will prove too slow-growing to be deadly — by one estimate, in 2 of every 5 men whose cancer is caught through a PSA test. But there's no way to tell in advance who needs treatment.

"If we had a test that could distinguish between a cancer that was going to be aggressive and a cancer that was not, that would be fabulous," said Dr. Virginia Moyer of the Baylor College of Medicine, who chairs the task force, an independent expert group that reviews medical evidence for the government.

About 1 in 6 U.S. men will be diagnosed with prostate cancer at some point in their life. Yet the cancer society notes that in Western European countries where screening isn't common, 1 in 10 men are diagnosed and the risk of death in both places is the same. In the U.S., about 217,000 men are diagnosed with prostate cancer each year, and 32,000 die.

Why not screen in case there's a mortality benefit that studies have yet to tease out? The task force outlined the problem with that:

—Up to 5 in every 1,000 men die within a month of prostate cancer surgery, and between 10 and 70 more suffer serious complications.

—At least 200 to 300 of every 1,000 men treated with surgery or radiation suffer incontinence or impotence.

—Overall, Moyer said 30 percent of men who are treated for PSA-discovered prostate cancer suffer significant side effects from the resulting treatment.

Among the questions sure to be raised during the public comment period are how doctors should advise men with prostate cancer in the family or black men, who are at increased risk.

PSA testing also is used to examine men with prostate symptoms, and to check men who already have had prostate cancer. The new recommendation doesn't affect those uses.

Congress requires that Medicare cover PSA tests, at a cost of $41 million in 2009. Other insurers follow Medicare's lead, especially in light of conflicting recommendations.

Nor does the new recommendation mean that men who want a PSA test can't have one. If the rule is adopted — something the government will review once the task force hears comments and finalizes its guidance — it would just advise against doctors pushing it routinely.

"The truth is that like so many things in medicine, there's no one-size-fits-all," said Dr. Michael Barry of Massachusetts General Hospital who heads the Foundation for Informed Medical Decision-Making that backs ways to help patients make their own choices.***

"A good stickgrappler has good stick skills, good grappling, and good stickgrappling and can keep track of all three simultaneously. This is a good trick and can be quite effective." - Marc "Crafty Dog" Denny

A succession of large-scale human studies, including two published earlier this month in leading medical journals, suggests that multivitamins and many other dietary supplements often don't have health benefits—and in some cases may even cause harm.

After decades of research on the possible benefits of nutritional supplements, the handwriting is on the wall: Vitamins look to be a bust for the majority of people, many leading scientists are concluding. Shirley Wang has details on Lunch Break..The data have prompted some nutrition researchers to say taking vitamins is a waste of money for those without a specific nutrient deficiency or chronic illness. Such findings have also fueled a debate about whether the field should continue conducting expensive human trials to figure out whether particular supplements affect health.

"The better the quality of the research, the less benefit [supplements] showed," says Marion Nestle, professor of nutrition, food studies, and public health at New York University. "It's fair to say from the research that supplements don't make healthy people healthier."

For instance, vitamins B-6 and B-12 are often touted as being good for the heart, but several studies have failed to find that they lower risk of cardiovascular disease, according the Office of Dietary Supplements, part of the National Institutes of Health. Vitamin C hasn't been shown in many studies to lower a person's risk of getting a cold. Calcium, while important to bone health, doesn't lower risk of heart disease or cancer and may increase risk of kidney stones.

"We have an enormous body of data telling us that plant-rich diets are very healthy," says Josephine Briggs, head of the National Center for Complementary and Alternative Medicine, another NIH center. "As soon as we take these various antioxidants[and other nutrients] out and put them in a pill, we're not consistently getting a benefit."

Researchers and nutritionists are still recommending dietary supplements for the malnourished or people with certain nutrient deficiencies or medical conditions. For instance folic acid—the supplement form of folate——reduces the likelihood of a common birth defect if taken by pregnant women.

Studying the effects of vitamins and supplements in the real world is difficult, since people eat foods with multiple nutrients that can interact with supplements and skew results. And observational trials can only show an association, not cause and effect.

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Close(l-r) F. Martin Ramin for The Wall Street Journal (3); Diane Fields for The Wall Street Journal .That is one reason the Council on Responsible Nutrition, which represents the supplement industry, says it is too early to say supplements don't have health benefits. Duffy MacKay, the group's vice president of regulatory and scientific affairs, says lengthier studies may be required to show the benefits of some supplements.

Micronutrients, which include antioxidants like vitamin C, hormones like vitamin D and metals like iron, are essential to the body in small amounts because they help facilitate important reactions in and between cells. Too much of them, however, can cause problems.

The effectiveness of many dietary supplements remains untested and makers aren't required to do tests before selling a product. Still, about half of Americans reported taking at least one supplement a month in 2006, in the National Health and Nutrition Examination Survey published in April of this year. The supplement industry brought in $28 billion in sales in 2010, up 4.4% from 2009, according to Nutrition Business Journal, an industry trade publication.

Vitamin users may derive a benefit from the placebo effect, experts say. And they often are convinced the supplements make them feel better, regardless of what studies show.

"The thing you do with [reports of studies] is just ride them out, and literally we see no impact on our business," said Joseph Fortunato, chief executive of supplement retailer GNC Corp., according to a transcript of the company's third-quarter conference call with analysts last week.

"Consumers believe in our products," a spokesman for GNC said. GNC's revenue grew 15.5% in the third quarter of this year compared to a year ago and the stock, which closed at $25.08, is up 0.5% year-to-date.

Of growing concern to many scientists are the increasing hints of harm from vitamins.

The first red flags started emerging nearly 20 years ago. Researchers thought from early work that extra beta-carotene could help prevent lung cancer, but two randomized trials published in 1994 and 1996 showed an increased rate of lung cancer among smokers who took beta-carotene supplements.

Oncologist Mark Heaney of Memorial Sloan-Kettering Cancer Center in New York showed in laboratory work in 2008 that vitamin C appeared to inhibit the effect of chemotherapy drugs for cancer treatment. Subsequent research has shown vitamin C may inadvertently protect cancer cells more than normal cells.

A study published this month in the Journal of the American Medical Association, known as the SELECT trial, found that vitamin E—previously thought to lower risk of prostate cancer—actually increased the chance slightly. The risk could be mitigated by the simultaneous consumption of another micronutrient, selenium, the study says.

Multivitamins aren't faring much better. Results from the Iowa Women's Health Study, published earlier this month in the Archives of Internal Medicine, found in a sample of over 38,000 older women, multivitamin use over time was linked with a slight but statistically significant increased risk of earlier mortality.

A studyof 1,900 men and women in 15 cities across Europe published in 2008 in the European Journal of Nutrition followed healthy elderly individuals for 10 years. Among smokers in the study, those who took multivitamins were more likely to die younger than smokers who didn't.

Another large trial examining postmenopausal women in the NIH's Women's Health Initiative found no discernible impact from taking a multivitamin on preventing breast, lung or colorectal cancer, cardiovascular disease or premature death, according to the 2009 study published in the Archives of Internal Medicine.

Some experts warn against overemphasizing the potential harm of multivitamins because it isn't clear how that statistical uptick in risk of death would translate into actual increased risk in real life.

The consistent failure to show benefits has led researchers at the National Center for Complementary and Alternative Medicine and elsewhere to call for more lab experiments and small-scale studies of how the nutrients work, after over a decade of pursuing large, clinical trials of particular supplements' effectiveness.

"We've missed a step," says Alan Kristal, a professor of epidemiology at the University of Washington who studies the links between diet and cancer. "We need to understand the mechanism by which these things are acting."

Roberta Anding, a nutritionist at Texas Children's Hospital in Houston, says some people need multivitamins and other supplements, but she is cautious about the risk from high doses of micronutrients. "It's no longer nutrition when the doses become high, it's pharmacology," she says.

The best way to get micronutrients is through a balanced diet, she says.

"If you're looking at this as, 'At least I'm [taking a multivitamin],' but you're not exercising or eating well, then it is a waste of money," says Ms. Anding, a spokeswoman for the American Dietetic Association, a research and advocacy group

I agree with vaccinating the males too. Makes no sense to vaccinate the females but not the males who are giving it to them. Besides who wants venereal warts some strains of which will be prevented:

ATLANTA (AP) -- The controversial HPV shot given to girls should also be given to boys, in part to help prevent the spread of the virus through sex, a government medical panel said Tuesday.

The expensive vaccine, which protects females against cervical cancer, hasn't been popular. And doctors admit it will be a tough sell to parents of 11- and 12-year-old males, too.

For males, the vaccine is licensed to prevent genital warts and anal cancer. Experts say another key benefit of routinely vaccinating boys could be preventing the spread of the human papilloma virus to others through sex - making up somewhat for the disappointing vaccination rate in girls.

The Advisory Committee on Immunization Practices made the recommendation Tuesday. Federal health officials usually adopt what the panel says and asks doctors and patients to follow the advice.

The vaccine has been available to boys for two years but Tuesday's vote was the first to strongly recommend routine vaccination. Officials acknowledged the disappointing rate in girls encouraged them to take a new, hard look.

Just 49 percent of adolescent girls have gotten at least the first of the recommended three HPV shots, which have been recommended for girls for five years. Only a third had gotten all three doses by last year.

"Pretty terrible," said Dr. Anne Schuchat, a U.S. Centers for Disease Control and Prevention administrator who oversees the agency's immunization programs.

She attributed the low rates for girls to confusion or misunderstanding by parents that they can wait until their daughter becomes sexually active. It works best if the shots are given before a girl begins having sex.

The vaccine is approved for use in boys and girls ages 9 to 26; but it is usually given to 11- and 12-year olds when they are scheduled to get other vaccines.

The committee also recommended the vaccination for males 13 through 21 years who have not been vaccinated previously or who have not completed the three-dose series.

Tuesday's vote follows recent studies that indicate the vaccine prevents anal cancer in males. A study that focused on gay men found it to be 75 percent effective. But while anal cancer has been increasing, it's still a fairly rare cancer in males, with only about 7,000 cases in the U.S. each year that are tied to the strains of viruses targeted in the HPV vaccine. In contrast, about vaccine-preventable 15,000 cervical cancers occur annually.

Some feel it's unlikely that most families will agree to get their sons vaccinated primarily to protect girls. An estimated 50 percent to 80 percent of men and women are infected with HPV in their lifetimes, although most clear the infection without developing symptoms or illness, according to the CDC.

The threat of genital warts hasn't been persuasive yet, either: Some data suggest that less than 1.5 percent of adolescent males have gotten the vaccine.

Its use against anal cancer may not be much of a selling point, said Dr. Ranit Mishori, a family practice doctor in Washington, D.C., and an assistant professor at the Georgetown University School of Medicine.

Some parents may say "`Why are you vaccinating my son against anal cancer? He's not gay! He's not ever going to be gay!' I can see that will come up," said Mishori, who supports the committee's recommendation.

There are two vaccines against HPV, but Tuesday's vote applies only to Merck & Co.'s Gardasil, which costs $130 a dose. The other vaccine wasn't tested for males.

There is NO question whatsoever antidepressants work in people. Not always, not in all people, with possible side effects, but they absolutely do work overall. That said we continue to see stuff like this:

NEW YORK (Reuters Health) - Neither antidepressants nor "talk therapy" were able to outperform inactive placebo pills in a new clinical trial on depression treatment -- though there were hints that the effects varied based on people's sex and race, researchers report.

The findings, published in the Journal of Clinical Psychiatry, add to evidence that people receiving "real" depression treatment in studies -- from antidepressants to St. John's wort -- often do no better than people given a placebo.

A recent review found that a minority of antidepressant users even fared worse than placebo users.

In this latest study, researchers randomly assigned 156 depression patients to either take the antidepressant sertraline (Zoloft and other brands) daily for 16 weeks; undergo a form of psychotherapy called supportive-expressive therapy (twice a week for four weeks, then weekly for 12 weeks); or be in a placebo group given inactive pills.

After 16 weeks, there were no overall differences in how the three groups fared.

Of antidepressant patients, 31 percent were treatment "responders" (meaning they'd fallen below a certain score on a standard measure of depression symptoms, or had seen their score drop at least 50 percent.)

The same was true of about 28 percent of patients in the talk-therapy group, and 24 percent in the placebo group. The differences among the three groups were so small as to be likely due to chance.

"I was surprised by the results. They weren't what I'd expected," said lead researcher Jacques P. Barber, dean of the Institute of Advanced Psychological Studies at Adelphi University in Garden City, New York.

Still, he stressed in an interview, the lack of benefit over placebo does not mean that depression therapies are pointless.

For one, Barber said, receiving a placebo in a clinical trial "is not the same as getting no treatment."

Study participants in placebo groups have contact with health professionals who are asking about their symptoms and well-being, Barber pointed out. And for some people, that attention can make a difference -- and may help explain the placebo response seen in studies.

In addition, at least some people in placebo groups believe they are getting the real treatment. And some studies have suggested that people's beliefs about their therapy play a key role in whether they get better.

But apart from that, different people may respond differently to a given type of depression therapy. Barber's team found some evidence of that.

The study, which focused on urban, low-income adults with major depression, had an unusually large minority population for a clinical trial on depression: Of the 156 patients, 45 percent were African American.

And Barber's team found that African-American men tended to improve more quickly with talk therapy than with medication or placebo.

In contrast, white men fared best on placebo, while black women showed no differences in their responses to the three treatments.

Only white women, Barber said, showed the expected pattern: a quicker response to both medication and talk therapy than to the placebo.

But all of that is based on fairly small numbers of people, and more research is needed to see if the gender and racial differences are real, according to Barber.

A psychiatrist not involved in the study agreed. "Those findings are interesting, but need to be interpreted with a grain of salt," said Dr. David Mischoulon, an associate professor of psychiatry at Harvard Medical School.

EVERYTHING WORKS TO SOME DEGREE?

As for the overall lack of benefit from the real treatments over placebo -- in this and other studies -- Mischoulon cautioned against reading that as "nothing works for depression."

"I think it's the opposite," he told Reuters Health, "It's more that, everything seems to work to some degree."

Like Barber, Mischoulon said that the placebo condition in clinical trials is not really "no treatment."

His advice for people suffering from depression symptoms is to talk with your doctor about the pros and cons of all the treatment options, including different forms of talk therapy and medication.

"I try to offer as broad a menu of options as possible, because all may potentially help," said Mischoulon, who has also studied alternative depression remedies, like fish oil and acupuncture.

Another caveat from the current study, he noted, is that it looked only at two types of medication. (Some patients were switched to another drug, venlafaxine (Effexor), if they did not respond to sertraline after eight weeks). And it tested just one type of talk therapy.

Supportive-expressive therapy is a short-term form of psychoanalysis that aims to help people understand how their personal relationships are related to their symptoms.

It's different from cognitive behavioral therapy, the best-studied form of talk therapy for depression. Both Barber and Mischoulon said it's not clear if the current findings would extend to psychotherapies other than supportive-expressive therapy.

"This is one type of psychotherapy, and it's two antidepressants," Mischoulon said. "It would be wrong to conclude that psychotherapy doesn't work, and antidepressants don't work."

The study was funded by the National Institutes of Health. Some of Barber's co-researchers have received funding from the pharmaceutical industry.

Arizona coma patient now speaking, walkingBy TERRY TANG | AP – 5 hrs agoPHOENIX (AP) — It will be a special Christmas for the family of a 21-year-old University of Arizona student who was nearly taken off life support before awaking from a coma.Sam Schmid was walking and speaking Friday at a Phoenix hospital. Dressed in a T-shirt, shorts and sneakers, he was able to use a walker and talk in brief sentences."Right now, I'm feeling all right ... except for the rehabilitation, I'm feeling pretty good," Schmid said.Doctors at Barrow Neurological Institute say Schmid has a long recovery ahead of him to regain full speech, balance and memory abilities.Schmid was involved in an Oct. 19 car crash in Tucson that left him with a brain aneurysm, among other life-threatening injuries. Because of the complexity of his brain injury, Schmid was flown to Phoenix.He underwent surgery performed by Dr. Robert Spetzler. With no responsive signs, staff discussed taking Schmid off life support."They never approached me to say would I donate his organs," said Susan Regan, Schmid's mother. "The people that were surrounding us were just asking about Sam, his quality of life, what would Sam want if we had to come to a difficult decision."Spetzler said Schmid was never officially classified as a potential organ donor. And after an MRI scan showed he wasn't at a point of no hope of survival, Spetzler recommended keeping him alive for one more week.Then on Oct. 24, Schmid shocked doctors by following commands to hold up two fingers."It may not seem like a lot to you," Spetzler said. "It's an incredible loop to show brain ability. That was like fireworks going off."Since then, Schmid has been spending his days in physical rehabilitation. Dr. Christina Kwasnica, who is overseeing Schmid's rehabilitation, said he has gone from practicing sitting in a chair to doing rehab three hours a day. She described his recovery so far as amazing but hesitated to make any predictions of what "normal" would be for him."It's so early in Sam's injury. We have no idea where the ceiling is," Kwasnica said.While he will be able to spend Christmas day with family in Phoenix, Schmid will not officially be released until next week. His brother, John, based in Tucson, will relocate to Phoenix so Schmid can continue rehabilitation on an out-patient basis.Schmid, who is a business major and was coaching basketball at a University of Arizona recreation center, is holding onto the belief that he can get back to what his life was like before the accident."I see myself leaving the house, going to school, work, basic things like that," Schmid said. "I just want my life to be what it used to be."

Head injuries can result in unknowable outcomes.Severe brain injury from lack of oxygen often called anoxic encephalopathy do not generally reverse.

I remember s woman who had a heart attack and was resucitated only to the extent her heart was revived. She was brain dead except for some primitive brain function. She was on a breathing machine and required total care and over ther period of around a year and half with endless hospital admissions, and infections, and bedsores, contractures, catheters, etc.

Her husband and son often would sit at the bedside. Doctors approached them now and then to "pull the plug".

For the longest time they refused. The response was always, suppose she is the one in million we read about in the news, on TV?

Hundreds of thousands of dollars (if not more) was spent on what after only a few weeks seemed futile. All of it paid for by Medicaid. Zero out of pocket. Some will say that even my mentioning the dollars makes me some sort of monster.

Eventually they finally agreed, I heard (I was just an occasional covering doctor), to "pulling the plug".

FDA changing course on antibiotics in livestockThe debate over the drug use in food animals continues as federal regulators tackle the issues of drug-resistance and shorter supplies.J. Adams, Special to the Los Angeles Times January 9, 2012

Only 20% of the antibiotics sold in the U.S. are given to people who are sick with bacterial infections, such as ear and urinary tract infections and pneumonia. Most of the penicillin, tetracycline and other antibiotic drugs used in this country are given to livestock that are perfectly healthy.Farmers have been putting these medicines in animal feed since the 1950s. They say the drugs help protect herds from infectious diseases and help animals grow faster.But for at least 40 years, the U.S. Food and Drug Administration has been concerned that the widespread practice may be fueling the growth of human pathogens that are no longer vulnerable to doctors' front-line drugs.In the last few weeks, the U.S. Food and Drug Administration has made two rulings addressing the use of antibiotics in animals that will end up as food on our dinner tables:• On Dec. 22, the FDA pulled the plug on procedures, begun in 1977, that might have ended the practice of feeding penicillin and tetracycline to livestock.• On Jan. 4, the agency issued an order that prohibits certain uses, including preventive uses, of another class of antibiotics also used to treat pneumonia and other infections in people.The two moves may seem contradictory. But the FDA asserts that both decisions were made in the interest of preserving antibiotics that are medically important for humans.Some public health advocates agree that the latest moves indicate a new willingness by the government to tackle the longstanding issue.In finally dropping its long-stalled plans to limit the use of penicillin and tetracycline in farm animals, the FDA signaled that it intends "to regulate more than just a few drugs," said Laura Rogers, who directs the Pew Charitable Trusts' campaign on human health and industrial farming. Seen in that light, last week's ruling limiting the use of cephalosporin antibiotics in agriculture "is the first step toward a broader regulatory approach," she said. (The Pew campaign opposes routine use of antibiotics in food animals.)The science behind antibiotic resistance is a classic story of survival of the fittest. Antibiotics target key life functions in bacteria, killing them or preventing them from multiplying. But individual bugs that survive a drug's assault will grow and multiply, potentially creating a whole population of drug-resistant bacteria.Resistance to antibiotics is a growing public health problem across the globe. People infected with resistant pathogens tend to get more severely ill and are harder to treat. Antibiotic resistance adds an estimated $20 billion to healthcare costs in the U.S. each year, including longer hospital stays and the need for more expensive drugs, according to the Centers for Disease Control and Prevention.However, it's not clear how much the use of antibiotics in cattle, pigs, chickens and other animals contributes to problems in people.Those who oppose the practice of putting antibiotics in animals' food or water point to studies that have found livestock-associated strains of bugs such as salmonella and Staphylococcus aureus in humans.Decades ago, the FDA commissioned Seattle's public health department to study salmonella and campylobacter found on meat and in people sick with enteritis. In a 1984 report, researchers found that illness-inducing campylobacter was similar to that found on poultry products. In addition, about 30% of bacteria from both sources were resistant to tetracycline.Eating contaminated meat isn't the only way people can become colonized with antibiotic-resistant bacteria. Those who work with farm animals are also at risk. For instance, a Chinese study published in 2010 found antibiotic-resistant Escherichia coli in animals and farmworkers. The year before, researchers in Iowa reported that they found a livestock-associated strain of antibiotic-resistant staphylococcus in pig farm workers.The World Health Organization, the American Medical Assn. and other major health groups have denounced the practice of feeding human antibiotics to animals. The mere threat that agricultural use could cripple drugs for people is reason enough to take action, they say.Advocates of the practice refer to scientific reviews that discount the risk to human health. A 2004 paper in the Journal of Antimicrobial Chemotherapy argued that cross-contamination between farm animals and people is a two-way street, with most antibiotic-resistant disease stemming from human use of these drugs. In any event, the authors wrote, illness from bacteria on meat can be prevented with proper cooking — even if the bacteria are resistant to drugs.Blanket regulations limiting how the drugs are used on animals would remove valuable tools from the veterinarian's medical bag, according to the American Veterinary Medical Assn. Using the drugs prophylactically allows farmers and ranchers to prevent or control disease outbreaks, especially when animals are kept in close quarters. If drugs are only given to animals after they are visibly ill, disease can spread quickly and risk the lives of an entire herd or flock.There's little dispute that livestock animals carry antibiotic-resistant organisms. But there's all sorts of barriers that prevent those bugs from infecting humans, said Dr. Liz Wagstrom, chief veterinarian for the National Pork Producers Council. They'd have to contaminate the meat at slaughter, survive cooking and be ingested in a large enough dose to make someone ill.In ending its long-stalled initiative to reconsider penicillin's and tetracycline's use in agriculture, the FDA said the "notices of opportunity for a hearing" issued in 1997 were so old that they were essentially useless. Though there was evidence back then that the practice fuels antibiotic resistance, new data would have to be taken into account for such a decision to be made today.At a minimum, any effort to move forward at this point would have to consider other classes of antibiotics that have become popular since the 1970s and include a rationale for which ones should be targeted, according to the agency.The FDA's move may have been prompted by a lawsuit filed by advocacy groups including the Natural Resources Defense Council and the Food Animal Concerns Trust. Convinced that feeding antibiotics to animals is a major public health problem, they were trying to force the FDA to move forward with its plans — not abandon them altogether."It's the FDA's overcautious attitude," said Steven Roach, public health program director for FACT. "If anything we have more evidence now than we did in 1977. And they had enough evidence to proceed back then."The drugs that were affected by the FDA's decision are among the oldest around. Tetracycline tops the list of most popular antibiotics, with more than 4 million kilograms used in food animals per year, according to 2009 data collected by the FDA. Penicillin comes in fourth, with about 610,000 kilograms of the drug used each year. (Both figures include drugs used on healthy animals as well as to treat those that are sick.)Both drugs still are widely used by pork producers but in very specific ways, Wagstrom says. For instance, penicillin (usually in combination with other antibiotics) is fed to weanling pigs because it stimulates growth at this early stage in life.How antibiotics promote growth is not entirely understood. The drugs may affect gut bacteria in a way that permits food nutrients to be better absorbed, or they may suppress low-level disease, according to Dr. H. Morgan Scott, a professor at Kansas State University's College of Veterinary Medicine in Manhattan, Kan. "If they're growing faster, some people would argue they must be healthier."The FDA has made other moves to restrict antibiotic use in animals. In 2003, the agency began requiring drug companies to do a risk assessment of drugs given to animals as part of the overall approval process. However, those rules don't apply to older drugs like penicillin, Roach said.The FDA is also developing guidelines for the "judicious use" of antibiotics in livestock. These guidelines, first made public in July 2010, are still in draft form. The agency hasn't set a timeline to finalize them, although it's considered a priority, according to FDA spokeswoman Stephanie Yao.But those guidelines will only be voluntary, which is why watchdog groups tried to force the FDA to move forward with the decades-old rules about penicillin and tetracycline, Roach said.The lawsuit brought by the NRDC, FACT and others to force the FDA to take regulatory action against antibiotics in animal feed is ongoing.Meanwhile, Rep. Louise Slaughter (D-N.Y.) has introduced legislation to restrict the use of medically important antibiotics in agriculture. The Preservation of Antibiotics for Medical Treatment Act would require the FDA to re-review approvals for drugs currently allowed in animal feed. Slaughter re-introduced the bill last March.

"Kudos to CCP for warnings given regarding Lap Band Surgery some time ago."

Thanks JDN.

I don't remember posting on this board about that.

Unfortunately outcomes for lap band are very disappointing. *Most* will gain the weight back and many do have problems later on.

The full bariatric restrictive/absorptive procedures are better. Yet I was recently surprised to find that contrary to expectations patients are not necessarily living a lot longer by what one would think is a life saving procedure. I think it depends on their co - morbid condidtions to start with.

I will try and see if I can find more recent information that I can post here. I don't recall the latest details.

Like the complete turnaround on PSA testing sometimes the longer one studies "outcomes" the more we realize we may not be doing as much good as thought.

That is one of the theoretical concepts behind electronic medical record data. That we will know more about long term effects of what we do and don't do. The jury is out on this. Overall I am not a big fan of it.

I received free a copy of the journal. I glanced through a somewhat long article but have not spent the time reading it.

This physician supports the use of it for medical purposes. I am not convinced we need another psychoactive drug out there. OTOH it is out there anyway I guess. Here he is giving a 10 minute chat about it:

This makes sense to me. I absolutely do not believe antidepressants are not better than placebo. I don't understand the findings of some studies that suggest this. There is NO doubt they are helping some people. It cannot just be placebo. No way. Yet even in this study only one in five benefits (or at least more than placebo) and it appears other modalities may be just as good:

..Study suggests overall benefit from antidepressantsBy Genevra Pittman | Reuters – 10 hrs ago....Email......NEW YORK (Reuters Health) - Despite recent debate about how well antidepressants really work in people with only mild or moderate depression, a new analysis of drug studies suggests they may have some benefit across the board.

Researchers found that more patients taking Prozac or Effexor had a substantial improvement in their symptoms than those taking a drug-free placebo pill, regardless of how severe those symptoms were to begin with.

The idea that unless you're very, very ill, you're not going to benefit from treatment does not appear to stand up" when looking closely, said the study's lead author, Robert Gibbons, from the University of Chicago.

Still, not everyone in the studies improved -- on average, about five people had to be treated with one of the drugs for one person to feel better, and the benefits seemed to be diminished among some of the oldest patients.

What's more, one researcher not involved in the study said its findings still don't mean the drugs are any better than non-drug methods of treating depression, such as talk therapy and being more physically active.

For their analysis, Gibbons and his colleagues looked at outcomes for each individual patient in published and unpublished trials testing the effects of six weeks of treatment with antidepressants versus placebo pills. Most of those trials were funded and run by the pharmaceutical companies that manufacture Prozac and Effexor -- Eli Lilly and Wyeth, respectively.

They included 12 studies of Prozac in adults and four each in elderly patients and youth, as well as 21 trials of immediate- or extended-release Effexor in adults. About 9,000 participants were included.

More adults and kids taking Prozac, known generically as fluoxetine, had at least a 50 percent improvement in scores on depression tests after six weeks compared to those assigned to take a placebo pill.

Fifty-five percent of adults on Prozac responded to treatment, compared to 34 percent in the placebo group. In youth, 30 percent on Prozac had significant symptom improvement, compared to just six percent of the comparisons.

The benefits were seen regardless of how severe patients' symptoms were before starting treatment.

However, in the elderly the differences between the treatment and placebo groups were much smaller, and the researchers calculated that 17 older patients would have to be treated with Prozac for one to gain from it.

Clearly the efficacy of antidepressants is age-dependent, (and) largest, most interestingly, in youth, which I don't think would be the mainstream view in psychiatry," Gibbons told Reuters Health.

The findings, he added, raise other questions that need to be followed up (including), what's going on in the elderly?"

Both types of Effexor, or venlafaxine, also seemed to help adults with mild to severe depression, with slightly more patients responding to the immediate-release dose.

Some of the study's authors have testified for or received funding from drug companies, though the report itself was funded by national health agencies.

The researchers said they couldn't be sure there would be similar improvements with other types of antidepressants -- especially given the more limited data in kids and the elderly -- or that the longer-term benefits would be as clear.

One recent study suggested that up to a fifth of patients on the antidepressant Cymbalta (duloxetine) might actually benefit more from placebo pills (see Reuters Health story of December 9, 2011.)

Irving Kirsch, who studies antidepressants and placebos at Harvard Medical School in Boston, said the new report didn't make him more optimistic about the drugs.

If five or more patients need to be treated with an antidepressant for one to substantially improve, most don't get much out of it, he pointed out.

More than 80 percent of the patients are not getting a significant benefit from the drug -- either they're not getting better or they would get the same benefit with placebo," he told Reuters Health.

There are alternative treatments for depression that also produce about the same symptom reduction as the drugs do, but without the risk of side effects," Kirsch added, including psychotherapy and exercise.

Still, Gibbons said that the improvement in symptoms for the average patient wasn't insignificant.

Definitely it doesn't look like antidepressants are placebos," he concluded.

I mention my own notion here that the massive use of antibiotics by the cattle and poultry industry to stimulate faster growth in chickens and cattle with the attendant side effect of dosing us regularly with these antibiotics, which are not neutralized by the act of cooking, may have more than a little to do with this.======================

Gastrointestinal infections are killing more and more people in the United States and have become a particular threat to the elderly, according to new data released last week.

Deaths from the infections more than doubled from 1999 to 2007, to more than 17,000 a year from 7,000 a year, the Centers for Disease Control and Prevention reported. Of those who died, 83 percent were over age 65. Two thirds of the deaths were caused by a bacterium, Clostridium difficile, which people often contract in hospitals and nursing homes, particularly when they have been taking antibiotics. The bacteria have grown increasingly virulent and resistant to treatment in recent years. But researchers were surprised to discover that the second leading cause of death from this type of illness was the norovirus. It causes a highly contagious infection, sometimes called winter vomiting illness, that can spread rapidly on cruise ships and in prisons, dormitories and hospitals. “I think there is perhaps a misperception that norovirus causes a mild illness,” said Aron Hall, an epidemiologist at the disease centers. “But this suggests a major problem that requires some attention.” Both diseases are spread by the fecal-oral route, meaning that people swallow germs found in feces, often spread by people who did not wash their hands after using the toilet. Problems with C. difficile are not new: Health officials first began warning in 2004 that a more virulent and drug-resistant strain had emerged. It produces high amounts of two potent toxins that can wreak havoc in cells lining the intestine. But few people anticipated what gains the bacteria would make. Among hospitalized patients, cases rose to 336,000 in 2009 from 139,000 in 2000. Deaths from the infection seem to have leveled off in the past few years, but researchers say they are still far too high and should be dropping, as other hospital-related infections are. Estimates of cases occurring outside hospitals run as high as three million annually. Overall, C. difficile infections cost $1 billion a year, according to the disease centers. Two factors typically lead to the infection: taking antibiotics, which make the intestine vulnerable, followed by exposure to the bacteria or their spores in a hospital, clinic or nursing home that has not been properly disinfected. Spores can survive for weeks or maybe even months outside the body, and it takes bleach or other strong disinfectants to kill them. Many people recover once they stop taking antibiotics, but some become severely ill and require treatment with different antibiotics to get rid of C. difficile. Even then, 20 percent relapse, and some suffer intestinal damage that can be fatal or can require surgery to remove part of the intestine. In recent years, some people have received fecal transplants, in which stool from a healthy person is placed into the patient’s intestine. The idea is to restore the normal balance of bacteria in the gut, which may include 25,000 to 30,000 different species. There is simply no better way to replace them. Awful as they may sound, the transplants can cure cases that were otherwise intractable. “The microbes have been at this a lot longer than us,” said Dr. L. Clifford McDonald, a medical epidemiologist at the disease centers. He added, “Our bodies have learned over eons how to keep harmful bacteria out.” Health officials expressed frustration at a news conference this month, stating that many cases are preventable or at least treatable, and yet death and infection rates have continued at “historically high and unacceptable levels.” Because nearly all C. difficile infections — 94 percent — come from hospitals or other health care settings, experts say doctors, nurses, other health workers and hospitals should take much of the responsibility for trying to fight them. A quarter of the infections start in the hospital, and the rest occur in nursing home patients or people recently treated in doctors’ offices or clinics. Patients often carry the germs from one institution to another. Simple hygiene measures are highly effective, like cleaning surfaces with bleach and wearing gowns and gloves when treating infected people to avoid spreading germs to other patients. One of the disturbing and more disgusting facts about C. difficile is that it is very hard to remove from bare hands: neither soap and water nor alcohol-based hand sanitizers work very well. For health workers, it is much better to wear gloves, to avoid contaminating their hands in the first place, Dr. McDonald said.

He also said that a recent study of hospitals in the United States that set up programs to fight C. difficile found that they were able to lower infection rates by 20 percent in two years. Similar efforts in Britain have cut infection rates by half.

It is also important to use antibiotics only when they are really needed, because people taking them have 7 to 10 times the usual risk of contracting C. difficile while using the drugs and for a month after, and triple the risk for the next two months, according to the disease centers. For those with serious illnesses that require antibiotics, the risk is unavoidable. But half the antibiotics prescribed in the United States are unnecessary, experts say, so people are being put at risk for no reason. But why have the bacteria become more virulent? A likely reason, Dr. McDonald said, is that virulence can sometimes be an asset when it comes to evolution. Nice germs finish last, but nasty ones that cause a lot of diarrhea will spread around more, infect more people and beat out the competition — a trait that evolution will tend to favor. “The strain that is more successful is selected for,” he said. The finding on norovirus came as a surprise, said Dr. Hall, the C.D.C. epidemiologist, whose report is the first to find that the virus has become the second leading cause of death from gastroenteritis. The virus causes about 800 deaths a year in the United States, he said, but about 50 percent more in years when new strains emerge. About 20 million people a year in the United States get sick from norovirus, most often in the winter. It can quickly sweep through a nursing home or dormitory. Just a small dose of the virus, a few particles, is enough to cause illness. “Someone sick is shedding billions of viruses in every gram of stool,” Dr. Hall said. “One person can expose a lot of people rapidly.” The incubation period is short, and the virus can persist on surfaces for days or even weeks. Cold and moisture help it last. Older people are most likely to become severely ill and die from the virus, either from dehydration or aspiration pneumonia, caused by inhaling vomit. “The second highest death rate is in kids under 5,” Dr. Hall said. When children die from the infection, the culprit is often dehydration, which can lead to shock and heart problems. Dr. Hall said that he and his colleagues estimated that 27 children a year die from norovirus, similar to the number killed by another gastrointestinal infection, rotavirus, for which there is now a vaccine. Researchers are trying to develop a norovirus vaccine, he said. But scientists say vaccines for intestinal infections are among the most difficult to create.

A subject upon which I have commented previously. I am sympathetic to govt. action here on the basis of external diseconomies:

By JENNIFER CORBETT DOOREN in Washington and MARK PETERS and IAN BERRY in ChicagoA federal judge ordered the Food and Drug Administration to restart a process that could limit the use of two types of antibiotics in cattle, pigs and poultry, amid concerns such use leads to antibiotic-resistant infections in humans.

In a ruling late Thursday, Judge Theodore Katz in New York said the FDA needed to start the process of no longer allowing penicillin and tetracyclines to be used on livestock for non-medical reasons.

That could wind up materially cutting the amount of antibiotics used in animal feed, addressing a decades-long concern of safety advocates. But the exact outcome remains unclear. Drug makers will be allowed to request a hearing to show that such uses of their products are safe, and any final rule-tightening could get watered down along the way.

In 1977, the FDA concluded that using low doses of penicillin and tetracyclines was not safe, and issued a notice stating it would start the process of withdrawing the approval for use of such drugs for non-medical uses. But it never followed through to stop the practice.

Last year, consumer groups, including the Natural Resources Defense Council, sued the FDA in federal court asking a judge to order the agency to follow through on its 1977 proposal.

In the 1950s, the FDA had approved the use of antibiotics to stimulate growth of cattle, swine and chickens. However, it was later shown that widespread use of antibiotics in livestock can cause the development of drug-resistant bugs that can be transferred from animals to humans.

"For over 35 years, FDA has sat idly on the sidelines largely letting the livestock industry police itself," said Avinash Kar, an attorney at the Natural Resources Defense Council.

"In that time, the overuse of antibiotics in healthy animals has skyrocketed—contributing to the rise of antibiotic-resistant bacteria that endanger human health," he said.

The FDA said it was studying the opinion and considering the appropriate next steps.

Agriculture experts and farmers said many livestock producers have already cut back or eliminated indiscriminate use of antibiotics altogether, and predicted the rule wouldn't change their operations anytime soon.

"A lot of people have the perception that people are using medication without rhyme or reason, and that's not the case," said Lisa Becton, head of swine health information and research for the National Pork Board.

The National Cattlemen's Beef Association, which represents beef producers, said it was disappointed with the court ruling that would require the FDA to use a strict administrative process to regulate antibiotic use.

"Cattle producers work hand-in-hand with veterinarians and animal-health experts each day to implement comprehensive herd-health management plans, which include the judicious use of antibiotics to prevent, control and treat any cattle health issues," the group said.

Leon Sheets, a hog producer, in Ionia, Iowa, said he didn't expect the requirement would change his operations anytime soon. "Antibiotics can be one of those tools" used to manage illness, but farmers already gauge their use in part because of the cost of the drugs, Mr. Sheets said.

Earlier this year, the FDA banned non-medical uses of a class of antibiotics known as cephalosporins, which are sold for human use under brands including Keflex, Ceftin and Cedax, and are used to treat bone, urinary-tract and respiratory infections.

As of April 5, it will become illegal to use the products in healthy animals as a way to help prevent disease, though using them to treat a specific illness will remain legal. Cephalosporins, unlike penicillin and tetracyclines, were never approved by the FDA for non-medical use in animals.

Well the news of Ryan O'Neill and Buffett shows the confilicting facts about prostate cancer> One guy is youngish and has advanced incurable prostate cancer and may well die of it and the other sounds like he is one of those old guys that happens to have it, and from the way it sounds, will die of something else. I read recently 50% of men over 50 could have cancer in their gland and 75% over 80 do. This source is giving lower numbers (over 50% over age 80).

Recently we are told not to do PSA screening as it may be causing more harm than good as a screening test. Yet it sounds like Buffett probably had one done. "Stage 1" is reported. Yet the statistics would suggest that it is far more likely the finding in him, at that age, is incidental and not related to anything else. Yet one wonders if O'Neill was getting the screening tests. Based on the recent "evidence" (which could change next year) probably O'Neill would not even benefitted from the test even if he did have it.

Tweet22There’s a lot of exciting news coming from the University of Chicago where researchers found that a compound made in honeybees and hives seems to stop the spread of prostate cancer cells in mice.

The compound, called caffeic acid phenethyl ester or CAPE, is made from propolis, the resin honeybees use to patch holes in their hives. The product has been known and used for centuries as a natural remedy for teeth and skin, as well as a defense against viruses and bacteria.

When the researchers fed CAPE to mice that had early stages of the human form of prostate cancer, it seemed to stop the cancer in its tracks.

“Their tumors simply stopped growing,” said Richard Jones, the study’s author and a cancer researcher at the University of Chicago. “When we stopped feeding the mice CAPE, their tumors returned.”

After six weeks, the tumors in mice eating CAPE were 50 percent smaller than the tumors in mice not getting the compound, whose tumors kept growing unchecked. The CAPE mice also didn’t lose any weight during the treatment, which researchers said indicated that the compound was not overly toxic.

The researchers said the compound didn’t kill the cancer, but it appeared to stop the growth of the cancer cells by masking their ability to use a system of signals to detect nutrition. If cells don’t sense the presence of the food they need, such as glucose, they will stop growing.

The study was only in mice, and the compound has not yet been tested in human cancer patients. But Jones said the cell pathways targeted by CAPE are found in all mammal cells. He said he is hopeful that CAPE will prove useful against cancer in humans, most likely in combination with other available cancer therapies.

This is a look at the perils of aspertame. Similar videos are conspiracy type, so I can't and won't vouch for the veracity of this video. That said, my doctor told me last week that diet soda drinkers are "deluding themselves about the health benefits."

By JENNIFER CORBETT DOOREN People who suffer from chronic depression throughout their lives are more likely to develop dementia compared with people who aren't depressed, according to a study released Monday.

The study, by California researchers, sheds light on whether depression might cause dementia and Alzheimer's disease, or if it is merely an early sign of memory loss and other problems associated with dementia. Alzheimer's disease is the leading cause of dementia; the second-leading cause is impaired blood supply to the brain, resulting in what is known as vascular dementia.

"It's quite clear depression late in life can be an early sign of Alzheimer's," explained Rachel Whitmer, a study researcher and an investigator at the Kaiser Permanente Northern California Division of Research. "There's a lot of debate whether [depression] is really a risk factor for dementia, or if it just shows up."

Other factors elevate dementia risk.

People with more belly fat in middle age had higher rates of dementia when they reached old age. This held true even for people whose overall body weight was considered normal.

People who smoked in middle age had an increased risk of developing dementia and Alzheimer's disease later on. People who smoked two packs or more daily had more than double the risk.

People with high cholesterol in middle age had an increased risk of developing dementia and Alzheimer's disease in old ageSource: Kaiser Permanente

The findings, published in the May issue of Archives of General Psychiatry, add to the evidence that late-in-life depression is a likely early sign of Alzheimer's disease and suggest that chronic depression appears to increase the risk of developing vascular dementia. Adequate treatment for depression in midlife could cut the risk of developing dementia. The study is the first to examine whether midlife or late-life depression is more likely to lead to either Alzheimer's disease or vascular dementia over the long term.

To look at links between depression and dementia, Dr. Whitmer and other researchers looked at 13,535 long-term Kaiser Permanente members who had enrolled in a larger study in the period from 1964 to 1973 at ages ranging from 40 to 55 years old. Health information, including a survey that asked about depression, was collected at the time.

Researchers looked at whether the same people were depressed late in life, in the period from 1994 to 2000, and then looked at whether they were diagnosed with dementia or Alzheimer's disease in 2003. The participants' average age in 2003 was 81 and 57.9% were women. The study found depression present in 14.1% of subjects in midlife only, in 9.2% in late life only and in 4.2% in both.

Looking at those who later developed dementia, the study found 20.7% of study participants without depression developed dementia, compared with 23.5% of people who reported depression in midlife only and 31.4% of those who were depressed later in life. Among those who were depressed at both mid- and late-life, 31.5% developed dementia.

Researchers then did more analysis to tease out Alzheimer's diagnoses from the broader dementia category. They found people who were depressed in midlife but not late in life had no increased risk of developing Alzheimer's disease or vascular dementia. People who were depressed late in life were more likely to develop Alzheimer's while those depressed at both mid- and late life were three times as likely to develop vascular dementia.

Dr. Whitmer's research focused on people's health and how it affects brain aging. Previous studies she has conducted using Kaiser's database of long-term members, have shown that factors such as smoking, diabetes, high cholesterol and belly fat increase the risk of developing Alzheimer's and other brain diseases. A 2008 study looking at belly fat showed people who had more belly fat during middle age had higher rates of dementia when they reached old age. The finding held true even for people whose overall body weight was considered normal.

Kaiser Permanente Northern California is a large, nonprofit health maintenance organization that provides health services to more than one-quarter of the population in the San Francisco and Oakland, Calif., areas.

Dr. Whitmer's most recent study, conducted with researchers from the University of California in San Francisco, was funded by Kaiser Permanente, the National Institutes of Health and the Brain and Behavior Research Foundation.

Carson C. Chow deploys mathematics to solve the everyday problems of real life. As an investigator at the National Institute of Diabetes and Digestive and Kidney Diseases, he tries to figure out why 1 in 3 Americans are overweight.

We spoke at the recent annual meeting of the American Association for the Advancement of Science, where Dr. Chow, 49, gave a presentation on “Illuminating the Obesity Epidemic With Mathematics,” and then later by telephone; a condensed and edited version of the interviews follows.

You are an M.I.T.-trained mathematician and physicist. How did you come to work on obesity?

In 2004, while on the faculty of the math department at the University of Pittsburgh, I married. My wife is a Johns Hopkins ophthalmologist, and she would not move. So I began looking for work in the Beltway area. Through the grapevine, I heard that the N.I.D.D.K., a branch of the National Institutes of Health, was building up its mathematics laboratory to study obesity. At the time, I knew almost nothing of obesity.

I didn’t even know what a calorie was. I quickly read every scientific paper I could get my hands on.

I could see the facts on the epidemic were quite astounding. Between 1975 and 2005, the average weight of Americans had increased by about 20 pounds. Since the 1970s, the national obesity rate had jumped from around 20 percent to over 30 percent.

The interesting question posed to me when I was hired was, “Why is this happening?”

Why would mathematics have the answer?

Because to do this experimentally would take years. You could find out much more quickly if you did the math.

Now, prior to my coming on staff, the institute had hired a mathematical physiologist, Kevin Hall. Kevin developed a model that could predict how your body composition changed in response to what you ate. He created a math model of a human being and then plugged in all the variables — height, weight, food intake, exercise. The model could predict what a person will weigh, given their body size and what they take in.

However, the model was complicated: hundreds of equations. Kevin and I began working together to boil it down to one simple equation. That’s what applied mathematicians do. We make things simple. Once we had it, the slimmed-down equation proved to be a useful platform for answering a host of questions.

What new information did your equation render?

That the conventional wisdom of 3,500 calories less is what it takes to lose a pound of weight is wrong. The body changes as you lose. Interestingly, we also found that the fatter you get, the easier it is to gain weight. An extra 10 calories a day puts more weight onto an obese person than on a thinner one.

Also, there’s a time constant that’s an important factor in weight loss. That’s because if you reduce your caloric intake, after a while, your body reaches equilibrium. It actually takes about three years for a dieter to reach their new “steady state.” Our model predicts that if you eat 100 calories fewer a day, in three years you will, on average, lose 10 pounds — if you don’t cheat.

Another finding: Huge variations in your daily food intake will not cause variations in weight, as long as your average food intake over a year is about the same. This is because a person’s body will respond slowly to the food intake.

Did you ever solve the question posed to you when you were first hired — what caused the obesity epidemic?

We think so. And it’s something very simple, very obvious, something that few want to hear: The epidemic was caused by the overproduction of food in the United States.

Beginning in the 1970s, there was a change in national agricultural policy. Instead of the government paying farmers not to engage in full production, as was the practice, they were encouraged to grow as much food as they could. At the same time, technological changes and the “green revolution” made our farms much more productive. The price of food plummeted, while the number of calories available to the average American grew by about 1,000 a day.

Well, what do people do when there is extra food around? They eat it! This, of course, is a tremendously controversial idea. However, the model shows that increase in food more than explains the increase in weight.

In the 1950s, when I was growing up, people rarely ate out. Today, Americans dine out — with these large restaurant portions and oil-saturated foods — about five times a week.

Right. Society has changed a lot. With such a huge food supply, food marketing got better and restaurants got cheaper. The low cost of food fueled the growth of the fast-food industry. If food were expensive, you couldn’t have fast food.

People think that the epidemic has to be caused by genetics or that physical activity has gone down. Yet levels of physical activity have not really changed in the past 30 years. As for the genetic argument, yes, there are people who are genetically disposed to obesity, but if they live in societies where there isn’t a lot of food, they don’t get obese. For them, and for us, it’s supply that’s the issue.

Interestingly, we saw that Americans are wasting food at a progressively increasing rate. If Americans were to eat all the food that’s available, we’d be even more obese.

Any practical advice from your number crunching?

One of the things the numbers have shown us is that weight change, up or down, takes a very, very long time. All diets work. But the reaction time is really slow: on the order of a year.

People don’t wait long enough to see what they are going to stabilize at. So if you drop weight and return to your old eating habits, the time it takes to crawl back to your old weight is something like three years. To help people understand this better, we’ve posted an interactive version of our model at bwsimulator.niddk.nih.gov. People can plug in their information and learn how much they’ll need to reduce their intake and increase their activity to lose. It will also give them a rough sense of how much time it will take to reach the goal. Applied mathematics in action!

What can Americans do to stem the obesity epidemic?

One thing I have concluded, and this is just a personal view, is that we should stop marketing food to children. I think childhood obesity is a major problem. And when you’re obese, it’s not like we can suddenly cut your food off and you’ll go back to not being obese. You’ve been programmed to eat more. It’s a hardship to eat less. Michelle Obama’s initiative is helpful. And childhood obesity rates seem to be stabilizing in the developed world, at least. The obesity epidemic may have peaked because of the recession. It’s made food more expensive.

You said earlier that nobody wants to hear your message. Why?

I think the food industry doesn’t want to know it. And ordinary people don’t particularly want to hear this, either. It’s so easy for someone to go out and eat 6,000 calories a day. There’s no magic bullet on this. You simply have to cut calories and be vigilant for the rest of your life.

Look we would have to close 95% of the pizze places, Chinese restaurants, fast food joints, diners, restaurants, Chipoltes, KFC stop stocking supermarkets with every conceivable food from around the world, close all the bakeries, carvels on on and on and on.

There is no other way to do it than this or as I think the answer will only come from the pharmacuetical industry some day.

Oh my God. Please don't start with a fat tax. There is no end to this crap. This ain't going to work Make 30 million people deal with this to stop 2700 heart attacks a year - even if true is crap. Liberalism is the biggest darn cancer:

INDIANAPOLIS -- Health experts have been trying to combat obesity in America for years and have recently suggested a new way to solve the growing problem.

A new study suggests that imposing a fat tax on unhealthy food and drinks could help slim down expanding waistlines.

According to reports, more than 60 percent of Americans are overweight. Under the tax, a $4 cheeseburger would cost an extra 80 cents, RTV6's Stacia Matthews reported.

Some Hoosiers found the proposed fat tax hard to swallow.

"I don't think we should tax people and the way they run their lives,” one man said.

Others said a fat tax is palatable.

"I'd pay 20 percent. It's worth it,” one woman said. "I would eat a lot more healthy just to save more money.”

Researchers said a fat tax could drop obesity rates by 3.5 percent and prevent 2,700 heart-related deaths a year. The study also urged subsidies for healthier foods and veggies to make them more affordable.

Dr. Eric Wright, who heads the Department of Public Health at the Indiana University School of Medicine, said the fat tax falls right in line with other consumer products.

"We've applied tax to alcohol and tobacco and that has definitely shown through very many studies that it actually decreased use. So, the logic has been applied to fatty foods and preliminary evidence in Europe is that it’s very effective,” Wright said.

Researchers said Indiana spends $3.5 billion a year on obesity-related medical costs.

"The reality is, with two-thirds of the population being overweight or obese, that's what's driving up health care costs and you can either choose to pay now, or you can pay later,” Wright said.

Critics of the tax said people who choose to healthier foods should receive tax breaks and incentives. Copyright 2012 by TheIndyChannel.com All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Get this for your site Echo Blog Echo on Twitter Help – David PERSONIAL RESPONSIBILITY-whats that-NOT IN AMERICA-its everyones elses faultToday, 12:50:25 PM– Flag – Like – Reply – Delete – Edit – Moderate HsiaLin Boy Hey US government, stop trying to play God. You cannot say with a straight face that you "care" about anyones health while you allow alcohol to still be sold. Alcohol kills more people, both the users of and the victimized by..... than any other drug in the world. Just admit you are looking for yet another way to get your hands on peoples money.Today, 12:50:04 PM– Flag – Like – Reply – Delete – Edit – Moderate Jack The problem is that they will get used to the additional tax revenue and then not want the money flow to dry up if people stop eating the excessively taxed food items.Today, 12:49:48 PM– Flag – Like – Reply – Delete – Edit – Moderate Nilo Cantonjos ...and the solution to another problem is imposing more taxes?

What about stop punishing the corporations and start focusing on PERSONAL RESPONSIBILITY?

To liberals... the solution is to always TAX. Kinda stupid if you ask me... but then again, the liberal's mind is so clouded with sin, they can't right. What is right is wrong to them and what is wrong is right to them.Today, 12:48:38 PM– Flag – Like – Reply – Delete – Edit – Moderate Pat Kelsey Come on November.Today, 12:48:26 PM– Flag – Like – Reply – Delete – Edit – Moderate David the sad thing is-thes so called smart folks-lie to the voters just to get into office-them once thr in they do whatever they want-then when we try to remove them-Senetor HERRIE WORTHLESS REID-they take the money stolen from us to payoff acorn and the union heads to put them bck n office-as a smoker-I DONT PAY THR STUPID TAXES-i save $25/carton by rolling my own-i dont have kids so y shld i pay for that SCHIP tax-heres an idea-IF ANY CITY OR STATES PASSES A FAT TAX,SMOKING TAX OR ANY OTHER STUPID TAX-THEY SHLD JUST MAKE AGAINST THE LAW TO SELL-THAT WLD SOLVE THE PROBLEMToday, 12:46:31 PM– Flag – Like – Reply – Delete – Edit – Moderate Michael People are not fat because they over eat or lack activity. Ok some people are. But studies show that the majority of Obese people don't over eat or are super lazy. It is WHAT they eat that causes them to gain weight. And no I am not talking about just fast food, which definitely is an issue. But the fact that anything you buy at the supermarket is in fact bad for you. Yes, anything! unless you are buying all non GMO food, and non fructose corn syrup food. Also, Americans eat way to much meat and dairy.

To tax obese people you are not going to change the problem, just earn money from it. The problem lies in the fact that the organizations that say what a healthy diet is are bought by the big food producers. Change your DIET don't buy processed food, cut back on dairy and meats, and of course exercise more often.Today, 12:41:36 PM– Flag – Like – Reply – Delete – Edit – Moderate Britt Hall If they really wanted to curb obesity they would start by limiting the items you can buy with food stamps. We now have more folks using food stamps than ever before and I challenge anyone to go to your grocery store and watch what is being bought with food stamps and then take a look at the size of the people buying it. These folks are buying pure crap called food all on the public dole. Again, don’t take my word on it.. go to your store and see for yourself. But, does anyone think any democrat would even suggest food stamp recipients should be limited in what they can buy with our tax dollars!Today, 12:37:00 PM– Flag – Like – Reply – Delete – Edit – Moderate James Watson The time to nip this kind of "thinking" in the bud was when the government started going after smokers. As a smoker, I have watched over the years as voters (many of them obese, junk food eaters) voted to raise my taxes supposedly for cancer research, though it was really just to feed the government beast.

Tell me now why I should come to the aid of junk food eaters?

"First they came for the (fill in the blank), but I remained silent, for I was not a (fill in the blank)...."Today, 12:36:36 PM– Flag – Like – Reply – Delete – Edit – Moderate David but if you vote rupublician you will get folks like Mrs.Snow out of Main-The sad thing is thr was a man running for the Presiden of the US who has spent his 35 yrs in congress fighting for the Constution of the United States of American and everyone put him down as a kookie old man-we need 565 Congressman Dr.Ron Pauls in D.CToday, 12:34:49 PM– Flag – Like – Reply – Delete – Edit – Moderate T N McCoy This is going to be a tax on the lower income groups, because they are the customers buying these things. Now, Obama is attacking the poor, the rich, the middle class, the US as a whole, and Western civilization. How much more can we take before Revolution occurs?Today, 12:34:20 PM– Flag – Like – Reply – Delete – Edit – Moderate Jasonn I am opposed to the NANNY STATE and the feds sticking their noses in my life. Stick to national defense and and infrastructure like highways and leave the rest of everyday living to the folks.Today, 12:33:48 PM– Flag – Like – Reply – Delete – Edit – Moderate Michelle W I need a Big Government Mommy and Daddy to shephard me thru life.

The Government is what we the sheeple demand.Today, 12:32:54 PM– Flag – Like – Reply – Delete – Edit – Moderate H J here come big brother again. its not enough to impose higher energy costs on all of us to drive our cars, heat and cool our homes etc, its not enough for big brother to limit my water flow in my shower or ability to flush the toilet properly. its not enough that i have to wait a good couple of minutes for my light bulbs to heat up enough to provide some glimmer of light. its not enough that just about everything i do is regulated or taxed by the government. food prices are already sky high and when i want to go get an occaisional cheeseburger, big brother wants to tax me more too? Geezus H. Kryst!!!!!!!!!!Today, 12:31:38 PM– Flag – Like – Reply – Delete – Edit – Moderate meeee Maybe we should all stay home and let the Government deliver our groceries every week and tell us which day to eat certain things. That way we will be in compliance with the idiotic things they come up with.Today, 12:31:33 PM– Flag – Like – Reply – Delete – Edit – ModerateMoreSocial Networking by Echo

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CCP; I agree with you we don't need another tax, I deplore tobacco taxes, but as an occasional smoker (cigars only) which is probably more healthy than obesity, I noticed that taxes do play a role in persuading people to quit. Demand is elastic; as the price goes up, less people smoke or they smoke fewer per day. Apply the same theory to fast food, it might work. If my Big Mac cost $10.00 I would think twice (I don't eat fast food) before ordering one. Then again, I am against sin taxes and social engineering.

As a side note, I sometimes get cantankerous in my old age. I was quietly smoking a cigar outside when a fat woman walked by and quite rudely and aggressively said with a sneer, "Do you have to smoke that cigar; don't you know it's bad for your health." I replied, "Do you have to be so fat; don't you know, it's bad for YOUR health." Not to mention my eyes. Needless to say we did not continue the conversation. Frankly, I would be happier if people left each other alone. Let me smoke occasionally in peace outdoors and you can go to MacDonald's on a daily basis. And let's not tax either one of us.

I don't recall ever seeing anything written about a maximum benefit or limit to exercise before. So for me this is interesting. It was hard to believe that triathalons, extreme endurance sports, etc are not damaging to the body in the long term. Just the wear and tear....:

Interstingly for weight loss/maintenance 60 to 90 minutes a day is recommneded although not at extreme intensities. Her at lest 60 minutes is recommended for children.

Extreme exercise such as marathons may permanently damage the heart and trigger rhythm abnormalities, warn researchers.They say the safe ‘upper limit’ for heart health is a maximum of an hour a day - after which there is little benefit to the individual.A review of research evidence by US physicians says intensive training schedules and extreme endurance competitions can cause long-term harm to people’s hearts. Damage: Excessive endurance exercise can do long-term harm to the cardiovascular system, U.S. scientists sayActivities such as marathons, iron man distance triathlons, and very long distance bicycle races may cause structural changes to the heart and large arteries, leading to lasting injury.Lead author Dr James O’Keefe, of Saint Luke’s Hospital of Kansas City, said exercise was generally beneficial for health but could tip into becoming harmful when taken to excessive lengths.

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He said ‘Physical exercise, though not a drug, possesses many traits of a powerful pharmacologic agent.

A routine of daily physical activity can be highly effective for prevention and treatment of many diseases, including coronary heart disease, hypertension, heart failure, and obesity.However, as with any pharmacologic agent, a safe upper dose limit potentially exists, beyond which the adverse effects of physical exercise, such as musculoskeletal trauma and cardiovascular stress, may outweigh its benefits.’ Dangers: Too much physical exercise can cause musculoskeletal trauma and cardiovascular stressA review published in the medical journal Mayo Clinic Proceedings (must credit) looked at studies detailing the mechanisms, pathophysiology, and clinical manifestations of cardiovascular injury from excessive endurance exercise.Dr O’Keefe and colleagues said research suggests that extreme endurance training can cause transient structural cardiovascular changes and elevations of cardiac biomarkers, all of which return to normal within one week.But for some individuals, over months and years of repetitive injury, this process can lead to the development of patchy scarring of certain areas of the heart, and abnormal heart rhythms.In one study, approximately 12 per cent of apparently healthy marathon runners showed evidence for patchy myocardial scarring, and the coronary heart disease event rate during a two-year follow up was significantly higher in marathon runners than in runners not doing marathons.The review said it had been known that elite-level athletes commonly develop abnormal electrocardiogram readings.However, studies now show that changes to the heart triggered by excessive exercise can lead to rhythm abnormalities.Endurance sports such as ultramarathon running or professional cycling have been associated with as much as a five-fold increase in the prevalence of atrial fibrillation, or abnormal heart rhythms.Chronic excessive sustained exercise may also be associated with other heart problems including artery wall stiffening.Dr O’Keefe said lifelong vigorous exercisers generally have lower death and disability rates compared with non-exercisers, but it was becoming important to detect intense exercisers whose regime might put them at risk.The phenomenon has been dubbed Phidippides cardiomyopathy - after the fatal heart damage suffered by the original marathon runner. Suffering: Massive physical efforts like those delivered by professional cyclist can be harmful, scientists sayThe young Greek messenger in 490BC died suddenly after running 175 miles in two days, with the last leg of 26.2 miles from Marathon to Athens.His death was the first report of a sudden cardiac death of a long distance runner.Dr O’Keefe stressed the review findings should not undermine the message that physical exercise was good for most people.He said ‘Physically active people are much healthier than their sedentary counterparts. Exercise is one of the most important things you need to do on a daily basis.‘But what this paper points out is that a lot of people do not understand that the lion’s share of health benefits accrue at a relatively modest level.‘Extreme exercise is not really conducive to great cardiovascular health. Beyond 30-60 minutes per day, you reach a point of diminishing returns’ he added.Government guidelines recommend adults take aerobic exercise five times a week for 30 minutes or more for maximum health benefits.Children should have at least 60 minutes of moderate to vigorous exercise a day, including taking part in sports, brisk walking and running.Aerobic exercise is achieved through sports such as jogging, running, cycling, tennis and swimming.The level of aerobic exertion should be enough to raise the heart rate to 120 beats a minute or higher, which includes a brisk walk and swimming. But taking a stroll or even gardening is also regarded as healthy activity.

Harvard epidemiologist Willet (been around for decades [like me ] - I saw him give a lecture in West Palm Beach around 20 yrs ago) on sweeteners and health. One must remember epidemiology can show a relationshp but that is not necessariy causation and is usually only the first step in studying the relationship of different traits (at least in meidicine). As for my theory that Bloomberg's banning larger sodas is going to do nothing for slowing weight loss - Willet makes a case for Bloomberg here. I admit I had a patient come in just recently and tell me she lost weight and when I asked how - she replied she got rid of the sodas!

If Your Teeth Could Talk ... The Mouth Offers Clues to Disorders and Disease; Dentists Could Play Larger Role in Patient Care• By MELINDA BECKThe eyes may be the window to the soul, but the mouth provides an even better view of the body as a whole. Some of the earliest signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue—sometimes long before a patient knows anything is wrong.

WSJ 'Personal Journal' Senior Editor Melinda Beck explains that one's teeth and gums hold a lot of details about the body's overall health. Also, don't be fooled by a bright set of pearly whites. Tom Gannam/AP Images for Crest and Oral-BThere's also growing evidence that oral health problems, particularly gum disease, can harm a patient's general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications. "We have lots of data showing a direct correlation between inflammation in the mouth and inflammation in the body," says Anthony Iacopino, director of the International Centre for Oral-Systemic Health, which opened at the University of Manitoba Faculty of Dentistry in Canada in 2008. Recent studies also show that treating gum disease improves circulation, reduces inflammation and can even reduce the need for insulin in people with diabetes. Such findings are fueling a push for dentists to play a greater role in patients' overall health. Some 20 million Americans—including 6% of children and 9% of adults—saw a dentist but not a doctor in 2008, according to a study in the American Journal of Public Health this month. "It's an opportunity to tell a patient, 'You know, I'm concerned. I think you really need to see a primary care provider,' so you are moving in the direction of better health," says the study's lead researcher Shiela Strauss, co-director of statistics and data management for New York University's Colleges of Nursing and Dentistry.

George Kivowitz, a restorative dentist with offices in Manhattan and Newtown, Pa., says he has spotted seven cases of cancer in 32 years of practice, as well as cases of bulimia, due to the telltale erosion of enamel on the back of the upper front teeth, and methamphetamine addiction. "We call it 'meth mouth,' " he says. "The outer surface of teeth just rot in a way that's like nothing else." Some of the most distinctive problems come from uncontrolled diabetes, Dr. Kivowitz adds. "The gum tissue has a glistening, shiny look where it meets the teeth. It bleeds easily and pulls away from the bone—and it's all throughout the mouth." An estimated six million Americans have diabetes but don't know it—and several studies suggest that dentists could help alert them. A 2009 study from New York University found that 93% of people who have periodontal disease are at risk for diabetes, according to the criteria established by American Diabetes Association.It's not just that the same lifestyle habits contribute to both gum disease and high blood sugar; the two conditions exacerbate each other, experts say. Inflammation from infected gums makes it more difficult for people with diabetes to control their blood-sugar level, and high blood sugar accelerates tooth decay and gum disease, creating more inflammation. Diabetes also complicates dental-implant surgery, because it interferes with blood vessel formation and bone growth. "When you put a dental implant in, you rely on the healing process to cement it to the jaw, so you get a higher failure rate with diabetes," says Ed Marcus, a periodontist in Yardley, Pa., who teaches at the University of Pennsylvania and Temple University dental schools. Dr. Marcus notes that about 50% of periodontal disease is genetic—and even young patients can have significant bone loss if they have an unusually high immune response to a small number of bacteria. Giving such patients a low dose of doxycycline daily can help modify the immune response. "It doesn't really control the bacteria, but it helps reduce the body's reaction," he says. There's also growing evidence that the link between periodontal disease and cardiovascular problems isn't a coincidence either. Inflammation in the gums raises C-reactive protein, thought to be a culprit in heart disease."They've found oral bacteria in the plaques that block arteries. It's moved from a casual relationship to a risk factor," says Mark Wolff, chairman of the Department of Cariology and Comprehensive Care at NYU College of Dentistry. Bacteria from the mouth can travel through the bloodstream and cause problems elsewhere, which is why people contemplating elective surgery are advised to have any needed dental work performed first.The American Heart Association no longer recommends that people with mitral valve prolapse (in which heart values close abnormally between beats) routinely take antibiotics before dental procedures, since it's now believed that oral bacteria enter the bloodstream all the time, from routine washing, brushing and chewing food. But the American Heart Association, the American Medical Association and the American Orthopedic Association all urge people who have had a full joint replacement to take an antibiotic one hour before any dental visit for the rest of their lives to reduce the risk of post-surgical infections. "I have my guidelines taped to the door in my hygienists' room," Dr. Kivowitz says.Dentists say they also need to stay up to date with all medications, supplements and over-the-counter drugs their patients are taking. Blood thinners can create excess bleeding in the mouth. Bisphosphonates, often prescribed for osteoporosis, can severely weaken jaw bones. Both should be stopped temporarily before oral surgery. Antihypertensive drugs, calcium-channel blockers and some anti-inflammatory drugs can cause painful ulcerations of the gums. Many medications, from antidepressants to chemotherapy drugs, cause dry mouth, which can cause cavities to skyrocket, since saliva typically acts as a protective coating for teeth. Additional fluoride treatments can help. Some proactive dentists have glucose monitors for another check on blood-sugar levels if they suspect diabetes. Some also take patients' blood pressure and hold off on invasive procedures if it's extremely high.The Centers for Disease Control and Prevention recommends that dentists offer HIV testing, because some of the first symptoms appear in the mouth, including fungal infections and lesions. Dentists can do the HIV test with a simple mouth swab and get results in 20 minutes. Breaking the bad news is often more difficult. "I went into oral surgery because I didn't think I would have to deliver that kind of news to patients," says Clifford Salm, an oral and maxillofacial surgeon in Manhattan who has found leukemia, lymphoma, AIDS and metastatic breast cancer after performing biopsies on suspicious spots. "It can be a difficult conversation," he says, "but most patients are very grateful."A gleaming, white smile is a sign of a healthy mouth, right? Not necessarily."Whiteness and the health of your teeth are totally unrelated," says Mark Wolff, an associate dean at New York University College of Dentistry. In fact, many dentists worry that people who whiten their teeth may have a false sense of complacency, since their teeth can still be harboring tooth decay and serious gum disease. Even people who have no cavities can still have inflamed and infected gums. It could be that their saliva is particularly protective of their tooth enamel, while their brushing and flossing habits, needed to keep gum tissues healthy, could be lax. "I get these patients in their mid-30s who don't have cavities, so they haven't been to a dentist in 10 years. But they have full-blown periodontal disease," says George Kivowitz, a restorative dentist in Manhattan. "They are losing all the supporting structure, and I have to tell them that these gorgeous teeth will fall out of your head if we don't turn this around." Using whitening products more often than recommended can erode some of the enamel and cause teeth to appear translucent. But whether that actually harms teeth is controversial. "No one has really shown that it's damaging, but no one knows the long-term results," says Dr. Marcus, the periodontist in Yardley, Pa.Write to Melinda Beck at HealthJournal@wsj.com

If there is no such thing as a healthy hot dog, how do you limit the damage at this weekend’s weenie roast?

Don’t count on the label to help much. Those pricey “natural” and “organic” hot dogs often contain just as much or more of the cancer-linked preservatives nitrate and nitrite as that old-fashioned Oscar Mayer wiener.And almost no one knows it because of arcane federal rules that make the labels on natural and organic hot dogs, luncheon meats and bacon virtually impossible to decipher when it comes to preservatives. That includes products made from beef, pork, turkey and chicken.

“If you actually surveyed consumers going out of their way to buy no-nitrate products, they’d be very surprised to learn that there’s plenty of nitrates in there,” said Bruce Aidells, a chef and cookbook author. “It’s very misleading.” In a role reversal, food manufacturers are now pushing the federal government for more truthful labeling that would allow them to tell consumers clearly that some products contain nitrate and nitrite, just from natural rather than synthetic sources. The current rules bizarrely require products that derive the preservatives from natural sources to prominently place the words “Uncured” and “No nitrates or nitrites added” on the label even though they are cured and do contain the chemicals.

“Nitrite is nitrite and consumers should be aware of what they’re eating,” said Marji McCullough, director of nutritional epidemiology for the American Cancer Society, which recommends that people reduce consumption of processed meats because of studies that link them to colon cancer.

The United States Department of Agriculture says it is aware of the labeling problem and may take a fresh look. “We feel strongly that labels should help consumers make informed decisions and we are open to reviewing additional information to enhance accuracy in labeling,” said a spokesman for the department. Nitrate and nitrite have been used for centuries to cure meat, giving products like hot dogs, bacon and ham their characteristic flavor and color and killing the bacteria that causes botulism. Today, conventional meat packers typically use a synthesized version known as sodium nitrite.

But companies that label their products natural or organic must use natural sources of the preservatives. They usually employ celery powder or celery juice, which are high in nitrate. A bacterial culture is used to convert that to nitrite. The resulting chemicals are virtually identical to their synthetic cousins. When the products are packaged, both conventional and natural products contain residual amounts.

A study published earlier this year in The Journal of Food Protection found that natural hot dogs had anywhere from one-half to 10 times the amount of nitrite that conventional hot dogs contained. Natural bacon had from about a third as much nitrite as a conventional brand to more than twice as much.

The current U.S.D.A. labeling rules require natural products to indicate there may be naturally occurring nitrate or nitrite, but it often appears in small print. When combined with the more prominently displayed “No nitrates or nitrites added” banner, many consumers are left scratching their heads.

“The most consistent feedback we get is, ‘I don’t understand what that means,’ ” said Linda Boardman, president of Applegate Farms, the leading brand of natural and organic processed meats. “It’s confusing and it’s not adding anything to the consumer decision-making process.”

Applegate and other natural companies have proposed alternate wording to the U.S.D.A. in the past without success. They say they are confident their products offer enough other benefits — all natural ingredients, meeting the standards for the humane treatment of animals, for example — that it is best to be upfront with consumers about the preservatives. Ms. Boardman said tests showed the amount of nitrite and nitrate in Applegate products was similar to conventional brands.

Consumer advocates agree the problem does not lie with the meat companies. “We see the problem lying squarely with U.S.D.A.,” said Urvashi Rangan, technical policy director of Consumers Union.

Since the 1970s, concerns about the health effects of nitrate and nitrite have focused on the potential for nitrite to combine with meat protein to form carcinogenic substances called nitrosamines.

The U.S.D.A. responded by limiting the amount of nitrate and nitrite that goes into processed meats, and today they contain far less than they did 40 years ago.

But since the health concerns first emerged, scientists have gained more understanding of the role of nitrate and nitrite in human health and have discovered the preservatives also have benefits, for example, in the healthy functioning of the cardiovascular and immune systems.

Some in the meat industry have seized on these discoveries to dismiss as outdated the link between nitrite in processed meat and cancer. They insist processed meats are safe.

But many scientists say the evidence of health risks remains persuasive. While the occasional hot dog or piece of bacon is probably O.K., they point out that high levels of salt and saturated fat in processed meats also contribute to health problems.

“What’s very clear is that consuming processed meats is related to higher risk of diabetes, heart attacks and colon cancer,” said Dr. Walter C. Willet, chairman of the nutrition department of the Harvard School of Public Health. “If you tweak the cured meat a little bit like some of these new products, that’s no guarantee that’s going to make it any better.”

And that weekend weenie roast? George L. Siemon , the chief executive of Organic Prairie, an organic meat processor, said that when he tried selling meats with no nitrates from any source, they didn’t taste the same and no one wanted them.

“We tried the non-anything,” he said. “It just didn’t work for the customer.”

In an effort to develop new ways of diagnosing and treating diseases, scientists are increasingly tracking the various patterns by which the body senses and reacts to stimuli.

Such patterns, commonly referred to as body rhythms, are a constant dynamic. A foot senses a crack in the sidewalk and the brain instructs the muscles to compensate so the person doesn't fall down. Within the body, when cells detect too much carbon dioxide, the lungs respond by taking a breath. To get the right response, neurons, or nerve cells, communicate by emitting electrical impulses that are picked up by other neurons.

Researchers are finding that measuring these electrical impulses can reveal the presence of disease. Recent studies have shown that children with autism have significantly different brain-wave patterns than children without the disorder. Other studies have found that brain waves in people with epilepsy behave differently shortly before a seizure.

James Collins, a researcher at Harvard University's Wyss Institute for Biologically Inspired Engineering, in Boston, has been investigating what he calls balance-control rhythms to understand why people are less steady on their feet as they get older and what can be done to correct that.

The growing emphasis on understanding how the body's dynamics change over time contrasts with more common diagnostic techniques, including monitoring chemicals in the body such as blood sugar and cholesterol or looking for abnormalities in brain structures. Such traditional methods may offer only limited information by providing just a snapshot at one point in time. Recent, computer-based analytical tools are also making it easier to sift through the highly complex data captured from body-rhythm monitoring.

Dr. Collins, using sensory floor devices, has been exploring the many little ways that young and old people adjust their body position and weight distribution to maintain balance as they stand or walk. The body is constantly sensing the changing environment and telling us to compensate so that we stay on track and don't topple over. Without this corrective ability, humans would be inherently unstable, "like pencils standing on end," says Dr. Collins, who is also a professor of biomedical engineering at Boston University.

As people age, the mechanisms for sensing the ground under their feet erode, and the body is no longer as good at shifting its weight and correcting a step when it needs to, which is a big reason why the elderly have more difficulty balancing, says Dr. Collins. Poorer balance raises the risk of falling.

Keeping TimeThe body's physiological rhythms work on different time scales and often interact with each other. A rhythm that has gone awry can indicate the presence of disease. Here are some examples:

• Circadian rhythm—The body's 24-hour cycle is associated with many important biological functions, including sleep and body weight. Studies in animals also have linked it to fertility.

• Ultradian rhythm—These are cycles that occur multiple times in a day and can involve various parts of the body, including cardiovascular, respiratory and hormonal systems.

Source: WSJ reporting .Dr. Collins and his colleagues have been experimenting with ways to help older people improve their balance. The solution they have been testing seems counterintuitive: Adding more fluctuations beneath the foot for the body to detect can enhance balance-control rhythms.

When the body has to deal with more random vibrations when someone is standing, it appears to enhance the body's ability to detect the signals that help with balance, according to Dr. Collins's research.

The scientists tested their hypothesis by creating special shoe inserts—gel-like insoles with embedded chips that cause random vibrations that are too subtle to be noticed. The idea is to sensitize people's ability to detect movement so they can better recognize real fluctuations on the ground.

In one study, balance was measured in 12 older people with a mean age of 73 and 15 young people, mean age of 20. When outfitted with the vibrating insoles, the older people's balance improved relative to that of the younger participants. The study was published in the Lancet in 2003.

Dr. Collins says he also has found similar improvements in balance-control rhythms in tests using the vibrating insoles with small numbers of elderly diabetic patients whose disease had led to nerve damage in the feet. That research was published in the Annals of Neurology in 2006.

A shoe-insert prototype is currently in clinical-trial testing, and the research team plans to file for Food and Drug Administration approval as a medical device in coming months, Dr. Collins says.

Researchers also are studying other rhythms in the brain to understand a variety of diseases, including epilepsy, autism, schizophrenia and dementia.

Frank Duffy, director of developmental neurobiology at Boston Children's Hospital, in June published a study online in BMC Medicine showing that kids with autism have distinguishable brain patterns.

Dr. Duffy and colleagues measured electrical brain-wave activity in 430 children with characteristic symptoms of autism, such as social-skill deficits and communication problems, and in 540 other children without apparent autism. The children, who didn't engage in any prescribed activity, each wore a cap with 32 electrodes attached to measure 16 different wave frequencies.

The differences in connectivity between the two groups' brain waves were significant, especially in the region of the brain responsible for language, which could have potential for help with diagnosis. When the researchers used the differences to predict which of the children had an autism diagnosis and which didn't, they were able to do so with 90% accuracy. Although the patterns need further study, Dr. Duffy says the technique appears to establish a physiological benchmark for autism.

Mark Cunningham, a faculty member in neural dynamics at Newcastle University in the U.K., has studied brain rhythms with the aim of predicting seizures in people with epilepsy. In a study published online in Epilepsia in June, Dr. Cunningham and colleagues examined direct electrical activity in patients' brains through electrodes that had previously been implanted for treatment purposes. The researchers noticed one type of wave, known as glissandi, with a unique pattern prior to a seizure. Unlike most brain waves, which move more slowly over time, the glissandi started moving faster. The researchers suggest that glissandi could someday be a target for treating epilepsy.

In Treatment for Leukemia, Glimpses of the Future• ST. LOUIS — Genetics researchers at Washington University, one of the world’s leading centers for work on the human genome, were devastated. Dr. Lukas Wartman, a young, talented and beloved colleague, had the very cancer he had devoted his career to studying. He was deteriorating fast. No known treatment could save him. And no one, to their knowledge, had ever investigated the complete genetic makeup of a cancer like his. So one day last July, Dr. Timothy Ley, associate director of the university’s genome institute, summoned his team. Why not throw everything we have at seeing if we can find a rogue gene spurring Dr. Wartman’s cancer, adult acute lymphoblastic leukemia, he asked? “It’s now or never,” he recalled telling them. “We will only get one shot.” Dr. Ley’s team tried a type of analysis that they had never done before. They fully sequenced the genes of both his cancer cells and healthy cells for comparison, and at the same time analyzed his RNA, a close chemical cousin to DNA, for clues to what his genes were doing. The researchers on the project put other work aside for weeks, running one of the university’s 26 sequencing machines and supercomputer around the clock. And they found a culprit — a normal gene that was in overdrive, churning out huge amounts of a protein that appeared to be spurring the cancer’s growth. Even better, there was a promising new drug that might shut down the malfunctioning gene — a drug that had been tested and approved only for advanced kidney cancer. Dr. Wartman became the first person ever to take it for leukemia. And now, against all odds, his cancer is in remission and has been since last fall. While no one can say that Dr. Wartman is cured, after facing certain death last fall, he is alive and doing well. Dr. Wartman is a pioneer in a new approach to stopping cancer. What is important, medical researchers say, is the genes that drive a cancer, not the tissue or organ — liver or brain, bone marrow, blood or colon — where the cancer originates. One woman’s breast cancer may have different genetic drivers from another woman’s and, in fact, may have more in common with prostate cancer in a man or another patient’s lung cancer. Under this new approach, researchers expect that treatment will be tailored to an individual tumor’s mutations, with drugs, eventually, that hit several key aberrant genes at once. The cocktails of medicines would be analogous to H.I.V. treatment, which uses several different drugs at once to strike the virus in a number of critical areas. Researchers differ about how soon the method, known as whole genome sequencing, will be generally available and paid for by insurance — estimates range from a few years to a decade or so. But they believe that it has enormous promise, though it has not yet cured anyone. With a steep drop in the costs of sequencing and an explosion of research on genes, medical experts expect that genetic analyses of cancers will become routine. Just as pathologists do blood cultures to decide which antibiotics will stop a patient’s bacterial infection, so will genome sequencing determine which drugs might stop a cancer. “Until you know what is driving a patient’s cancer, you really don’t have any chance of getting it right,” Dr. Ley said. “For the past 40 years, we have been sending generals into battle without a map of the battlefield. What we are doing now is building the map.” Large drug companies and small biotechs are jumping in, starting to test drugs that attack a gene rather than a tumor type. Leading cancer researchers are starting companies to find genes that might be causing an individual’s cancer to grow, to analyze genetic data and to find and test new drugs directed against these genetic targets. Leading venture capital firms are involved. For now, whole genome sequencing is in its infancy and dauntingly complex. The gene sequences are only the start — they come in billions of small pieces, like a huge jigsaw puzzle. The arduous job is to figure out which mutations are important, a task that requires skill, experience and instincts. So far, most who have chosen this path are wealthy and well connected. When Steve Jobs had exhausted other options to combat pancreatic cancer, he consulted doctors who coordinated his genetic sequencing and analysis. It cost him $100,000, according to his biographer. The writer Christopher Hitchens went to the head of the National Institutes of Health, Dr. Francis Collins, who advised him on where to get a genetic analysis of his esophageal cancer. Harvard Medical School expects eventually to offer whole genome sequencing to help cancer patients identify treatments, said Heidi L. Rehm, who heads the molecular medicine laboratory at Harvard’s Partners Healthcare Center for Personalized Genetic Medicine. But later this year, Partners will take a more modest step, offering whole genome sequencing to patients with a suspected hereditary disorder in hopes of identifying mutations that might be causing the disease. Whole genome sequencing of the type that Dr. Wartman had, Dr. Rehm added, “is a whole other level of complexity.” Dr. Wartman was included by his colleagues in a research study, and his genetic analysis was paid for by the university and research grants. Such opportunities are not available to most patients, but Dr. Ley noted that the group had done such an analysis for another patient the year before and that no patients were being neglected because of the urgent work to figure out Dr. Wartman’s cancer. “The precedent for moving quickly on a sample to make a key decision was already established,” Dr. Ley said. In Treatment for Leukemia, Glimpses of the Future• (Page 2 of 3) Ethicists ask whether those with money and connections should have options far out of reach for most patients before such treatments become a normal part of medicine. And will people of more limited means be tempted to bankrupt their families in pursuit of a cure at the far edges?

“If we say we need research because this is a new idea, then why is it that rich people can even access it?” asked Wylie Burke, professor and chairwoman of the department of bioethics at the University of Washington. The saving grace, she said, is that the method will become available to all if it works. A Life in Medicine It was pure happenstance that landed Dr. Wartman in a university at the forefront of cancer research. He grew up in small-town Indiana, aspiring to be a veterinarian like his grandfather. But in college, he worked summers in hospitals and became fascinated by cancer. He enrolled in medical school at Washington University in St. Louis, where he was drawn to research on genetic changes that occur in cancers of the blood. Dr. Wartman knew then what he wanted to do — become a physician researcher. Those plans fell apart in the winter of 2002, his last year of medical school, when he went to California to be interviewed for a residency program at Stanford. On the morning of his visit, he was nearly paralyzed by an overwhelming fatigue. “I could not get out of bed for an interview that was the most important of my life,” Dr. Wartman recalled. Somehow, he forced himself to drive to Palo Alto in a drenching rain. He rallied enough to get through the day. When he returned to St. Louis, he gave up running, too exhausted for the sport he loved. He started having night sweats. “I thought it might be mono,” he said. “And I thought I would ride it out.” But then the long bones in his legs began to hurt. He was having fevers. He was so young then — only 25 — and had always been so healthy that his only doctor was a pediatrician. So he went to an urgent care center in February 2003. The doctor there thought his symptoms might come from depression, but noticed that his red and white blood cell counts were low. And Lukas Wartman, who had been fascinated by the biology of leukemia, began to suspect he had it. “I was definitely scared,” he said. “It was so unreal.” The next day, Mr. Wartman, who was about to graduate from Washington University’s medical school, went back there for more tests. A doctor slid a long needle into his hip bone and drew out marrow for analysis. “We looked at the slide together,” Dr. Wartman said, recalling that terrible time. “It was packed with leukemia cells. I was in a state of shock.” Dr. Wartman remained at the university for his residency and treatment: nine months of intensive chemotherapy, followed by 15 months of maintenance chemotherapy. Five years passed when the cancer seemed to be gone. But then it came back. Next came the most risky remedy — intensive chemotherapy to put the cancer into remission followed by a bone-marrow transplant from his younger brother. Seven months after the transplant, feeling much stronger, he went to a major cancer meeting and sat in on a session on his type of leukemia. The speaker, a renowned researcher, reported that only 4 or 5 percent of those who relapsed survived. “My stomach turned,” Dr. Wartman said. “I will never forget the shock of hearing that number.” But his personal gauge of recovery — how far he could run — was encouraging. By last spring, three years after his transplant, Dr. Wartman was running six to seven miles every other day and feeling good. “I thought maybe I would run a half marathon in the fall.” Then the cancer came back. He remembered that number, 4 or 5 percent, for patients with one relapse. He had relapsed a second time. This time, he said, “There is no number.” His doctors put him on a clinical trial to try to beat the cancer with chemotherapy and hormones. It did not work. They infused him with his brother’s healthy marrow cells, to no avail. A Clue in RNA Dr. Wartman’s doctors realized then that their last best hope for saving him was to use all the genetic know-how and technology at their disposal. In Treatment for Leukemia, Glimpses of the Future• (Page 3 of 3) After their month of frantic work to beat cancer’s relentless clock, the group, led by Richard Wilson and Elaine Mardis, directors of the university’s genome institute, had the data. It was Aug. 31. The cancer’s DNA had, as expected, many mutations, but there was nothing to be done about them. There were no drugs to attack them. But the other analysis, of the cancer’s RNA, was different. There was something there, something unexpected. The RNA sequencing showed that a normal gene, FLT3, was wildly active in the leukemia cells. Its normal role is to make cells grow and proliferate. An overactive FLT3 gene might be making Dr. Wartman’s cancer cells multiply so quickly. Even better, there was a drug, sunitinib or Sutent, approved for treating advanced kidney cancer, that inhibits FLT3. But it costs $330 a day, and Dr. Wartman’s insurance company would not pay for it. He appealed twice to his insurer and lost both times. He also pleaded with the drug’s maker, Pfizer, to give him the drug under its compassionate use program, explaining that his entire salary was only enough to pay for 7 ½ months of Sutent. But Pfizer turned him down too. As September went by, Dr. Wartman was getting panicky. “Every day is a roller coaster,” he said at the time, “and everything is up in the air.” Desperate to try the drug, he scraped up the money to buy a week’s worth and began taking it on Sept. 16. Within days, his blood counts were looking more normal. But over dinner at a trendy St. Louis restaurant, he picked at his chicken and said he was afraid to hope. “Obviously it’s exciting,” he said. “But Sutent could have unanticipated effects on my bone marrow.” Maybe his rising red blood cell counts were just a side effect of the drug. Or maybe they were just a coincidence. “It’s hard to say if I feel any different,” Dr. Wartman said. And the cost of the drug nagged at him. If it worked, how long could he afford to keep taking it? The next day, a nurse at the hospital pharmacy called with what seemed miraculous news: a month’s supply of Sutent was waiting for Dr. Wartman. He did not know at the time, but the doctors in his division had pitched in to buy the drug. Two weeks later, his bone marrow, which had been full of leukemia cells, was clean, a biopsy showed. Still, he was nervous. The test involved taking out just a small amount of marrow. Cancer cells could be lurking unseen. The next test was flow cytometry, which used antibodies to label cancer cells. Again, there were no cancer cells. But even flow cytometry could be misleading, Dr. Wartman told himself. Finally, a yet more sensitive test, called FISH, was done. It labels cancer cells with fluorescent pieces of DNA to identify leukemia cells. Once again, there were none. “I can’t believe it,” his awe-struck physician, Dr. John DiPersio, told him. Dr. Wartman, alone in his apartment, waited for his partner, Damon Berardi, to come home from work. That evening, Mr. Berardi, a 31-year-old store manager, opened the door with no idea of Dr. Wartman’s momentous news. To his surprise, Dr. Wartman was home early, waiting in the kitchen with champagne and two flutes he had given Mr. Berardi for Christmas. He told Mr. Berardi he should sit down. “My leukemia is in remission,” he said. The men embraced exultantly, and Dr. Wartman popped open the champagne. “I felt an overwhelming sense of relief and a renewed vision of our future together,” Mr. Berardi said. “There were no tears at that moment. We had both had cried plenty. This was a moment of hope.” Hunches and Decisions Dr. Wartman and his doctors had fateful decisions to make, with nothing but hunches to guide them. Should he keep taking Sutent or have another bone-marrow transplant now that he was in remission again? In the end, Dr. DiPersio decided Dr. Wartman should have the transplant because without it the cancer might mutate and escape the Sutent. Meanwhile, Pfizer had decided to give him the drug. Dr. Wartman has no idea why. Perhaps the company was swayed by an impassioned plea from his nurse practitioner, Stephanie Bauer. Dr. Wartman’s cancer is still gone, for now, but he has struggled with a common complication of bone-marrow transplants, in which the white blood cells of the transplanted marrow attack his cells as though they were foreign. He has had rashes and felt ill. But these complications are gradually lessening, and he is back at work in Dr. Ley’s lab. His colleagues want to look for the same mutation in the cancer cells of other patients with his cancer. And they would like to start a clinical trial testing Sutent to discover whether the drug can help others with leukemia, or whether the solution they found was unique to Lukas Wartman. Dr. Wartman himself is left with nagging uncertainties. He knows how lucky he is, but what does the future hold? Can he plan a life? Is he cured? “It’s a hard feeling to describe,” he said. “I am in uncharted waters.” Monday: Promise and heartbreak.

In the second article of her three-part series, Gina Kolata of The New York Times tells the story of one family’s quest to save the life of a beloved mother and wife, Beth McDaniel, who was fighting a rare form of cancer. Her son Timothy, a molecular biologist, led the drive to get the genes of his mother’s cancer and healthy cells sequenced and analyzed. Scientists identified a gene aberration that led to a unique medical treatment. It seemed to stop the cancer cold, but all too soon the disease came roaring back.

Mrs. McDaniel’s experience offers a sobering look at the challenges of using an approach still very much in its infancy.

STOCKHOLM — Andemariam Beyene sat by the hospital window, the low Arctic sun on his face, and talked about the time he thought he would die. Two and a half years ago doctors in Iceland, where Mr. Beyene was studying to be an engineer, discovered a golf-ball-size tumor growing into his windpipe. Despite surgery and radiation, it kept growing. In the spring of 2011, when Mr. Beyene came to Sweden to see another doctor, he was practically out of options. “I was almost dead,” he said. “There was suffering. A lot of suffering.” But the doctor, Paolo Macchiarini, at the Karolinska Institute here, had a radical idea. He wanted to make Mr. Beyene a new windpipe, out of plastic and his own cells. Implanting such a “bioartificial” organ would be a first-of-its-kind procedure for the field of regenerative medicine, which for decades has been promising a future of ready-made replacement organs — livers, kidneys, even hearts — built in the laboratory. For the most part that future has remained a science-fiction fantasy. Now, however, researchers like Dr. Macchiarini are building organs with a different approach, using the body’s cells and letting the body itself do most of the work. “The human body is so beautiful, I’m convinced we must use it in the most proper way,” said Dr. Macchiarini, a surgeon who runs a laboratory that is a leader in the field, also called tissue engineering. So far, only a few organs have been made and transplanted, and they are relatively simple, hollow ones — like bladders and Mr. Beyene’s windpipe, which was implanted in June 2011. But scientists around the world are using similar techniques with the goal of building more complex organs. At Wake Forest University in North Carolina, for example, where the bladders were developed, researchers are working on kidneys, livers and more. Labs in China and the Netherlands are among many working on blood vessels. The work of these new body builders is far different from the efforts that produced artificial hearts decades ago. Those devices, which are still used temporarily by some patients awaiting transplants, are sophisticated machines, but in the end they are only that: machines. Tissue engineers aim to produce something that is more human. They want to make organs with the cells, blood vessels and nerves to become a living, functioning part of the body. Some, like Dr. Macchiarini, want to go even further — to harness the body’s repair mechanisms so that it can remake a damaged organ on its own. Researchers are making use of advances in knowledge of stem cells, basic cells that can be transformed into types that are specific to tissues like liver or lung. They are learning more about what they call scaffolds, compounds that act like mortar to hold cells in their proper place and that also play a major role in how cells are recruited for tissue repair. Tissue engineers caution that the work they are doing is experimental and costly, and that the creation of complex organs is still a long way off. But they are increasingly optimistic about the possibilities. “Over 27 years, I’ve become more convinced that this is doable,” said Dr. Joseph P. Vacanti, a director of the Laboratory for Tissue Engineering and Organ Fabrication at Massachusetts General Hospital and a pioneer in the field. In Mr. Beyene’s case, an exact copy of his windpipe was made from a porous, fibrous plastic, which was then seeded with stem cells harvested from his bone marrow. After just a day and a half in a bioreactor — a kind of incubator in which the windpipe was spun, rotisserie-style, in a nutrient solution — the implant was stitched into Mr. Beyene, replacing his cancerous windpipe. It was such a seemingly wild scheme that Mr. Beyene had his doubts when Dr. Macchiarini first proposed it. “I told him, I prefer to live three years and then die,” he said. “I almost refused. It had only been done in pigs. But he convinced me in a very scientific way.” Now, 15 months after the operation, Mr. Beyene, 39, who is from Eritrea, is tumor-free and breathing normally. He is back in Iceland with his wife and two small children, including a 1-year-old boy whom he had thought he would never get to know. In Stockholm earlier this year for a follow-up visit, he showed the long vertical scar on his chest and spoke quietly in English, the raspiness of his voice a leftover from radiation therapy. His strength was improving every day, he said, and he could even run a little. “Things are good,” Mr. Beyene said. “Life is much better.” Imitating NatureTo make an organ, it helps to know how nature does it. That is why Philipp Jungebluth, a researcher in Dr. Macchiarini’s lab, had mounted a heart and a pair of lungs inside a glass jar on a workbench and connected them by tubing to another jar containing a detergent-like liquid. The organs, fresh from a sacrificed rat, had slowly turned pale as the detergent dripped through and out of them, carrying away their living cells. After three days the cells were gone, leaving a glistening mass that retained the basic shape of the organs.

Page 2 of 3)These were the heart and lungs’ natural scaffolds, or extracellular matrix — intricate three-dimensional webs of fibrous proteins and other compounds that keep the various kinds of cells in their proper positions and help them communicate.

Labs around the world are now experimenting with scaffolds. In some cases the goal is to use the natural scaffolds themselves to build new organs — to take a donor lung, for example, strip all its cells and reseed it with a patient’s own cells. Why not use what nature has perfected, this line of thinking goes, rather than try to replicate it in a synthetic scaffold? Dr. Macchiarini and his team tried this beginning in 2008, successfully implanting reseeded windpipes from cadavers in about a dozen patients, most of whom are now living normal lives. Because the donor’s own cells are removed, this approach all but eliminates a major problem of transplants: the risk that foreign tissue will be rejected by the recipient. But it does not solve several other problems that may be just as troublesome. A donated windpipe may not be the right size; it has to be stripped of its cells and reseeded while the recipient waits; and the procedure still requires donor organs, which are in short supply. So for Mr. Beyene, the decision was made to produce a scaffold out of plastic. But all the work with natural windpipes proved useful. “We learned so much, starting from zero,” Dr. Macchiarini said. “We could have never done the artificial transplant without the past experience.” Made to OrderMr. Beyene’s synthetic scaffold was fabricated by scientists at University College London, using scans of his natural windpipe as a template. It was an exquisite piece of polymer engineering, tailor-made to fit his chest. But it was still just a lifeless piece of porous plastic. To become a working organ, the tiny spaces in the plastic needed to be filled with cells that would eventually function together as tissue. Not just any cells would do; Dr. Macchiarini and his team would start with stem cells. To ensure that the organ would not be rejected, the cells had to come from Mr. Beyene himself, which also bypasses the kind of ethical issues that have arisen over the use of embryonic stem cells. Mr. Beyene’s stem cells were obtained from his bone marrow. The cells were placed in nutrient solution and then dripped by pipette over the scaffold. It was like basting a turkey. Human stem cells are part of the body’s system for building and repairing itself. They begin as a blank slate, but are able to become specialized cells specific to particular tissues or organs like the windpipe. In recent years, scientists have made great advances in understanding how stem cells can differentiate in this way. The Stockholm team was hoping that with the help of stem-cell-stimulating drugs, the marrow cells placed on the windpipe would start to become the right kinds of cells on both the inside and outside of the organ. But Dr. Macchiarini does not think the process worked quite as planned. “I’m convinced that the cells we are putting in the bioreactor after two or three days are gone,” he said. But as they die they release chemicals that signal the body to send more stem cells from the bone marrow through the bloodstream to the site, aiding the regenerative process. Or at least that is what Dr. Macchiarini thinks happened. “We are far away from understanding this process,” he said. “Far, far away.” ‘If It Bleeds, It Lives’If you cannot cough, you’re dead. That sums up one of the important functions of the windpipe: keeping bacteria and other particles in the air out of the lungs, where they could cause potentially fatal infections. A normal windpipe is lined with specialized cells, including some that produce mucus that can trap the particles. Coughing then brings the mucus up and out.

Page 3 of 3)So one test of a tissue-engineered windpipe is whether it contains these specialized cells. In Dr. Macchiarini’s earlier work involving donor windpipes, he had seeded the inside with similar cells taken from the recipient’s nose. But with Mr. Beyene, Dr. Macchiarini was counting on stem cells to differentiate into these other kinds of cells, generating a lining for the windpipe. In November, five months after the surgery, Mr. Beyene’s windpipe was found to be partly lined with the specialized cells. And in the later follow-up visit, Dr. Macchiarini noted that the lining was still thriving, with no sign of infection. “And he is able to cough,” Dr. Macchiarini said. If the cells are surviving, that means the windpipe is developing a complex network of tiny blood vessels through the same regenerative process that produced the specialized cells. All tissues must have such a network so that every cell can get oxygen and nutrients. But developing one — or ensuring that one develops — is an enormous challenge for tissue engineers. “From the beginning, our view was that the principal barrier to this was going to be the blood supply,” said Dr. Vacanti, whose laboratory has long worked on developing a tissue-engineered liver, among other organs. Mr. Beyene’s doctors had one way to be certain that his windpipe was developing a blood vessel network. As part of their follow-up exam, they purposely injured the internal lining slightly. “If it bleeds, it lives,” Dr. Macchiarini said. Mr. Beyene’s windpipe bled. A Quest ContinuesMr. Beyene hopes to return someday to Eritrea and work as a geothermal engineer. But for now he remains in Iceland, to be close to Stockholm for regular follow-up visits. The windpipe contains only his own cells, so he does not need to take drugs to suppress his immune system to ward off rejection. But the synthetic scaffold, like any foreign material, caused the body to produce scar tissue, which had to be removed. While that is no longer a problem, Mr. Beyene does not know when, or if, he will be able to return home. “They have to say, ‘Things are perfect; you don’t need any more care,’ ” he said. “Nobody knows. This is the first case.” Last November, five months after Mr. Beyene’s surgery, Dr. Macchiarini implanted a bioartificial windpipe in another cancer patient, Christopher Lyles. He used an improved plastic scaffold, made up of even smaller fibers for the cells to be embedded in. Mr. Lyles returned home to Maryland in January but died in March. The family did not release the cause of death, but Dr. Macchiarini said that the implant had been functioning well. Despite that setback, in June Dr. Macchiarini performed similar operations on two patients in Russia. Both have been discharged from the hospital and are doing well, he said. Dr. Macchiarini is planning even more operations. But there needs to be a less complex and cumbersome solution, he said, beyond procedures that can cost up to half a million dollars. Because the need for this kind of work is potentially so enormous, “we cannot pretend that we can reseed with the specific cells outside the body,” he said. Instead, he envisions developing even better scaffolds and implanting them without cells, relying on drugs to stimulate the body to send cells to the site. His ultimate dream is to eliminate even the synthetic scaffold. Instead, drugs would enable the body to rebuild its own scaffold. “Don’t touch the patient,” Dr. Macchiarini said. “Just use his body to recreate his own organ. It would be fantastic.” Monday: Using animal scaffolding to get human tissue growing.